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121 East eleventh St. 
OAKLAND - - California 





121 East eleventh St. 

Oakland - - California 


?uliila Hetlth Centtr of 
-'Alameda Coit 

12, EAST tu ^^^ipoRNlA 










121 East Eleventh St. 

/-> ' i-r 






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Copyright, 1905, by 


W. B. 


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Dear Miss Nutting: — 

We take great pleasure in inscribing this little book to you 
in appreciation of the splendid work you are doing in 
maintaining a high standard for the nursing profession. 

Very sincerely, 



This little book has been prepared to meet a need in 
the training-school and as a handbook for nurses and 
laymen who are interested in the subject of feeding the 

At present the nurse must rely upon a knowledge of 
dietetics gleaned either from her text-book on invalid 
cookery or from one of the larger reference works upon 
the subject. The former contains too little, and the 
latter is much too large and too technical to be of great 
service to the busy nurse. 

The aim of this book is to give the essentials of 
dietetics. The physiology of digestion has been briefly 
reviewed. The various classes of foods and the part 
they play in nutrition have been considered. The sub- 
jects of infant feeding and the feeding of the sick have 
been fully discussed, and a brief outline has been given 
of the principles involved in the nourishment of patients 
suffering with the various diseases in which diet plays 
an important part in the management. Rectal alimenta- 
tion and the feeding of operative cases have been fully 
described. Diet lists and instructions have been added 
which should enable the nurse to comprehend and to 

intelligently carry out the orders of the physician. A 



large number of recipes for the invalid's dietary have 
been added. 

Should the reader desire further information on any 
of the subjects mentioned or concerning other dietetic 
topics he should consult our larger work, " Diet in Health 
and Disease." 

April 15, 1905. 




The Chemistry AND Physiology OF Digestion ii 

Digestion and Absorption — The Influence of V^arious Factors 
upon the Digestion — The Relation of Food to Various Inherent 
Conditions — Absorption of Foods — Quantity of Foo^i Required. 


Classes of Foods 32 

Animal Foods — Milk and Milk Products — Eggs — Meats and 
Meat Preparations — Fish — Vegetable Foods — Cereals — Legu- 
mes — Roots and Tubers — Green Vegetables — Fruits — Nuts — 
Sugars — Spices and Condiments — Fats and Oils — Salts — Bev- 
erages AND Stimulants — Water — Tea — Coffee — Cocoa — Al- 


Various Factors IN their Bearing on Diet 80 

Concentration of Food — Preservation of Food — Artificial Food 
Preparations — Cooking of Foods — Diseases Caused by Errors in 
Diet and by Various Food Poisons — Food Adulteration. 


Feeding of Infants and Children 95 

Milk-modification — Feeding during the Second Year — Diet of 
School Children — Feeding in Infant Asylums. 


The Feeding of Sick Infants 124 

Stationary Weight ; Loss of Weight — Colic — Vomiting — Gavi^e 
— Nasal Feeding — Feeding in Inflammations of the Mouth — 
Diseases of the Stomach — Diarrhea — Chronic Intestinal Indi- 
gestion — Constipation — Wasting Diseases — Rickets. 



Diet for the Aged 13^ 


Dirt During Pregnancy and the Puerperium 136 


Rectal Feeding 138 

Procedure — Recipes for Nutrient Enemata — Other Methods of 
Nourishing the lk>dy — Saline Injections and Infusions. 


General Rules for Fekdinc; the Sick 145 

Feeding Unconsci(jUK and Refractory Patients — Forced Feeding 
— Feeding in Fever. 


Feeding in the Infectious Diseasi<3 155 

Typhoid Fever — Typhus Fever — Small-pox — Scarlet Fever — 
MeaHles — Mumps— Whooping-cough — Diphtheria — Rheumatism 
— Yellow Fever— Tetanus — Rabies — Tuberculosis. 


Diet IN Di«EAHK»M OF THE Stomach .176 

I^uIms'n Diet Scale — Pcnzoldt's Diet-lists — Liquid Foods in Gas- 
tric Disorders— Sjiecial Factors Hearing on tlie Diet — Special 
Curtf — Diet in Dysphagia — Acute Gastritis — Chronic Gastritis — 
Dilatation of the Stomach — Atonic Dyspepsia — Ulcer of the 
Stomach — Hemorrhage from the Stomach — Carcinoma of the 
Stomach — Nervoun (iastrir Disorders. 


Dirt in Intpjitinai. Diseases 202 

Tntrstlnnl DyN))«pMia — Acute Tntrstinnl Catarrh — Chronic Intes- 
tinal Catarrh — Dysentery — IMeer of the Intestine— Malignant 
Growths of the Intestine — Acute Intestinal Obstruction — Chnmic 
tffstinal Olwtruetlon — Appendicitis -Dietetic Treatment of 
fvous Conditions of the Intestine — llem«>rrhoids — Diarrhea — 
)|tua1 ('onstipation PeritonitiM. 




Diet in Diseases of the Liver 218 


Diet in Diseases of the Rf^piratory Organs 222 

Pleurisy — Empyema — Laryngitis — Asthma — Chronic Lung Dis- 
ease — Pneumonia. , 


Diet in Diseases of the Circulatory System 225 

Diet in Diseases of the Heart — General Directions — Oertel Treat- 
ment — Aneurism ; Dilatation of the Blood-vessels — Angina Pec- 
toris — Anemia. 


Diet in Diseases of the Genito-urinary System 232 

Urine and Food — Acute Inflammation of the Kidney ; Nephritis 
— Chronic Inflammation of the Kidney — Movable and Floating 
Kidney — Calculous Affections — Surgical Diseases of the Genito- 
urinary Tract. 


Diet in DiSFjvsFi? of the Nervous System 237 

Neuralgia — Insomnia and Disturbed Sleej) — Epilepsy — Chorea — 
Apoplexy — Alcoholism — Rest Cure — Diet for the Insane. 


Diseases in which Dikt is a Primary Factor 253 

Diabetes Mellitus— (iout and Goutiness — Arthritis Deformans — 
Scurvy — Obesity — Leanness — Diet in Skin Diseases. 


Special Diet Cures 272 


Dietetic Managkment ok Surgical Cases 274 

Anesthesia and Diet —Diet after Operation — 0|^erations about the 
Head -Ilnre-lip nnd Cleft Palate Operations — Esophageal or 
Laryngeal Operations — Diet and Laparotomies — Nausea and 
Vomiting— Thirst — Care of the Bowels — Dietetic Management 
of Shock — Diet after Operations on the Various Organs — Feeding 
through Gastric and Intestinal Fistulas. 




Hospital Diet 283 


Recipes 285 

Beverages — Cereals and Cereal Gruels — Bread — Vegetables — 
Soups without Meat — Milk Preparations — Eggs — Meats — Soups 
— Methods of Preparing Raw Beef — Panopepton — Meat Jellies 
without Gelatin — Foods for Diabetics. 


Cuts of Meat 33^ 

Weights and Measures 337 

Index 34^ 

Dietetics for Nurses. 




Food is the matter taken into the body to supply heat 
and energy, to build up the body, and repair tissue waste. 

Every movement we make uses up a certain amount 
of energy ; this and all the heat that is dissipated from 
our bodies must be supplied by the food. The energy 
in the food is present in a resting or latent form in the 
power which binds atoms together in molecules and the 
molecules together into a mass. When the complex food 
forms are broken up into simpler compounds this energy 
is set free and is used by the body as energy or con- 
verted into heat. The excess is stored up in the body, 
usually as fat, in the subcutaneous tissue, or as glycogen 
in the liver and muscles. This energy is liberated by a 
series of changes which may be compared to the burning 
of coal or wood m a furnace, the difference being that 
the chemic changes are much more complicated, and the 
body is a much more perfect furnace than any which man 
has devised, as it can utilize a greater proportion of energy 
with much less waste. 

The structures of the body — ^bones, muscles, nerves, 
etc. — are built up after birth by material which is taken 
into the body as food. The wear and tear of the body 



necessitates continual repair of these tissues, and the 
material used for this also comes from the food. 

Food, as it is taken into the body, differs very much 
in composition from the material that can be utilized by 
the tissues in growth and the repair of waste. The proc- 
esses which prepare it for the use of the body are spoken 
of as digestion. 

The chemic elements contained in the body are also 
found in the food. Some fifteen elements are present in 
the body, the principal ones being oxygen, hydrogen, 
carbon, nitrogen, calcium, phosphorus, and sulphur. 
The compound substances which these make are classi- 
fied under the headings, protein , fats , c arbohydrates , 
mineral m atter or salts, and water. 

Water. — Water enters into the composition of every 
tissue in the body and forms over 60 per cent, of the 
entire body-weight. It is not burnt up, however, and so 
does not supply any energy. 

Salts* — These form about 6 per cent, of the weight 
of an adult man. They are present in the bones, teeth, 
and other tissues. The principal salts of the body are 
calcium phosphate and the various compounds of potas- 
sium, sodium, magnesium, and iron. The mineral salts 
are very necessary to life and health. 

Protein. — Under this heading are included most of 
the food-stuffs containing the element nitrogen. Protein 
is found in both animal and vegetable food, familiar ex- 
amples of it being the lean and gristle of meat, the white 
of eg^, the gluten of wheat, and the curd of milk. The 
word " proteid " is used by some writers to describe these. 
The proteins are often subdivided into alhtminoids, as the 
white of egg and the curd of milk ; gclatinoidSy as gelatin ; 
and extractives, such as the aromatic substances in beef-tea. 


The proteins are necessary for life. They are the only 
form of food which can build up and repair the body, if 
we except the fatty tissues, which may be replaced by 
protein, carbohydrate or fat. They also s upply energy 
and heat. If they are not supplied in sufficient quantity 
the body will waste and a condition of malnutrition 
come on. 

Carbohydrates contain no nitrogen. They are com- 
posed of carbon, hydrogen, and oxygen, the last two in 
the proportion to form water, hence the name carbohy- 
drate. They include starch, sugar , stnd the ve getable 
fiber or cellulose . C arbohydra tes are burnt up in tjie 
body and are the mos t i mportan t source of heat and 
energy. Excesses taken are converted into fat and 
stored up in the body. The superficial fat of the body 
protects it from cold and acts as a storehouse for the fat, 
which can be converted inta heat and energy. 

Pat, orjiydrocarbon, is an important element of food, 
serving the same purpose as the carbohydrates. Fat 
supplies more heat and energy, weight for weight, than 
carbohydrates, but is neither so easily digested nor so 
available. Fat is found in animal and vegetable food , as 
in the fat part of meat, butter , olive oil, and is present in 
large quantities in the yolk of egg. 

Atwater gives the following table to illustrate the uses 
of the different food elements : 

Nutritive Ingredients of Food, 

Food as 
contains — 

Edible portion — e, g., flesh 
of meat, yolk and white 
of egg, wheat, flour, etc* 




Mineral matter. 

Refuse- -^. g.^ bones, entrails, shells, bran, etc. 



• i 

Uses of Nutrients in the Body. 

Protcin^forttiu tiuhUCH — /*. ^^, white (albumin) of eggs 

cunl (cttsein) of milk, lean meat, gluten of wheat, etc. 
Kttln— arc Hlored nu fat — c, ^., fat of meat, butter, olive 

oil, oiU of corn, wheat, etc. 
CarbohydrsUeh— are trannformed into fat — e. g.y sugars, 

HtareheN, etc. 
Mineral mattcm (a«h) — share in forming bone, assist 

in (ligation — c, .^^, phosphates of lime, etc., )K)tash, 

MHla, etc. 


All serve as fuel 
to yield energy 
in the forms of 
heat and mus- 
cular power. 

The changes which take place in the body in " burn- 
\\\^ up " the food material are designated by the name 

The heat valueof the various foods may be determined 
by the use of an instrument known as a bomb calor- 
imeter, the result being expressed in calories, A^ calori e 
is the amount of heat that is necessary to raise the tem- 
perature of one kilogram of water i° C. It is nearly 
\ the same as the amount required to raise one pound of 
,' water 4*^ F. This expressed in the mechanical force, 
' that is, the amount of work it would do, means that a 
calorie would raise a ton about 1.54 feet, or that it is 
equal to 1.54 foot tons. Some authors ws^gram calories, 
and their figures are ICXX) times greater than those in 
mast general use. 

According to Atwater, the fuel-value of the various 
classes of fi>od as ordinarily supplied is as follows : 

I gram of niv^tein 4 caloric* 

I " fat S,Q •* 

I ** oai^^hvdmtc ' 4 

I |x>und I $20 calories. 
I " 4040 
I *' 1S20 


Tlicse figures arc somewhat lower than the figures 
gi\ en b\' older estimations, and arc based upon the most 
recent ox^x'rimeiUs. The fuel-values formerly given were : 
prvncin and carlx^hydratos. 4.1 calories per gram; fat, 
o ; calories |icr gram. It will be observed that fat has a 


very high food-value, which doubtless explains why it is 
stored up as a reserve fuel. 

The amount of energy used in mental work has never 
been determined. In an experimental chamber, where 
as alight an exertion as turning over in bed will be regis- 
tered by the thcrmometric scale, no change was produced 
by the inmate working out the most difficult mathcmatic 


The digestion of food takes place through a number 
of changes brought about by the action of a number of 
ferments or, as they are often called, enzymes. The food 
is so changed that the useful part can be absorbed and 
used by the body, wliile tlie remainder is passed off as 

Enzymes are supplied by a number of glands, as 
ptyahn in the saliva, pepsin in the gastric juice, and trypsin 
in the intestine. There are enzymes which change starch 
into sugar, some which change protein into soluble sub- 
stances, others which break up fats, still others acting on 
sugars, etc. The chemistry of these changes is usually 
that the enzyme causes the food substance to unite with 
water and separate into two .simpler compounds. 

On being taken into the mouth the food is broken up 
by chewing and mixed with the salivary juice, which acts 
on the starches and changes them into sugar. The 
chemic reaction of the saliva is alkaline. The food then 
passes into the stomach. The chemic reaction of the 
stomach or gastric juice is acid, and the action of the 
salivary juice is soon stopped. In the stomach the food 
is liquified and the proteins changed into peptones by the 
action of the pepsin. Milk is curdled by the action of 


another enzyme — rennin. After from one to several 
hours, according to the quahty and quantity of food 
taken, the liquid mixture in the stomach is passed into 
the intestines. Here the reaction is alkaline. A number 
of different juices act on the food at the same time. The 
liver supplies bile, the pancreatic gland a juice, the intes- 
tinal glands a secretion. 

The pancreatic juice contains several enzymes : trypsin, 
which acts like pepsin ; amylopshi, which acts like ptyalin, 
so that the digestion commenced in the mouth and stom- 
ach is completed. It also contains steapsitiy which acts 
on the fats, emulsifying them, that is, dividing them into 
little droplets like cream or a cod-liver oil emulsion, and 
also splitting the fats into glycerin and fatty acids. The 
bile from the liver assists in emulsifying fat and exerts an 
influence over the food, hindering putrefaction. The in- 
testinal juices aid in emulsifying fats, and act upon the 
starches and sugars. 

Absorption. — This occurs in two ways : either by 
the material absorbed entering directly into the blood 
through the capillaries in the intestines, and passing 
thence through the portal veins, or it is absorbed by 
little vessels in the lining of the intestine called lacteals, 
and from these it passes through the thoracic duct, a 
long tube connecting them with the veins (left jugular 
and subclavian), returning the blood from the upper part 
of the body. The food material in the second case enters 
directly into the blood-current. Little or no absorption 
takes place in the stomach. The* food enters the small 
intestine in a liquid condition and remains from 5 to 20 
hours, and is then passed into the large intestine, where 
the excess of water is absorbed and the refuse or feces 
passed off in a more or less solid form. 



Almost all the absorption of food takes place in the 
small intestine. The large intestine may absorb food 
under certain conditions, as when it is injected into the 
bowel (see Rectal enemata). 

The liver plays an important part in nutrition. It 
supplies bile, but that is a small matter compared to what 
is called its glycogenic function. The carbohydrate food, 
on reaching the liver, is changed to glycogen or animal 
starch. This glycogen is stored up in the liver and also 
in the muscles, and is burnt up in muscular action. 
The liver also takes care of the waste formed by the 
changes taking place in the body. These waste products 
are brought to the liver by the blood and changed into 
compounds which can be passed off from the body. 
There are a number of waste products, most important 
of which is m-ca, which may also be formed in the mus- 
cles. This urea enters the blood-stream and is passed 
off by the kidneys. 

The Digestion of Infents. — The salivary digestion 
is very feeble in early life. The sahvary glands are fairly 
active by the fourth month, and begin to play a more 
important role in the digestion about the eighth or ninth 
month. The stomach digestion is of less importance in 
infancy. One of the principal changes is the coagulation 
of the casein (curd) of milk. 

Heredity. — Certain di.seases or conditions which are 
affected by diet are apt to run in families, the most im- 
portant of these are obesity, gout, diabetes, and alcohol- 
ism. Food idiosyncrasies may be often inherited, as the 
urticaria (hives) caused by eating strawberries or shell- 



:. — Women, as a rule, require about four-fifths as 
much food as men, this may partly be due to the seden- 
tary life led. 

Ag^e. — Children require proportionately more food 
than adults. Atwater gives the following table of food 
requirements : 

Boy of 15-16 years requires 0.9 the food of a man at moderate work. 

Girl of 15-16 


<i (< 

Boy of 13-14 



(t (< 

Girl of 13-14 


« « 

Boy of 12 



(( (( 

Girl of 10-12 


(( << 

Boy of lo-ii 



« (( 

Child of 6-9 


(( (< 

Child of 2-5 



<< << 

Child under 2 



*< «( 









Old people require less than vigorous adults. 

Race and Climate. — Various races use different 
diets, depending much on the climate they live in. Cli- 
mate affects the diet largely by the supply it affords. 
More fat is required in cold chmates and during cold 
weather than in warm. The well clad require less food 
than those exposed to cold. 

Siise and Weight. — Other things being equal, the 
larger the body the more food is needed. 

Rest and Exercise. — Much less food is required 
during rest than during exercise. In exercise the mus- 
cular activity increases oxidation and tissue waste, and 
this waste must be counterbalanced by an increased com- 
sumption of food. 

Individual tendencies have some effect on the amount of 
food required. Some persons are obese and eat but little, 
and vice versa. 



Apart from the selection of a propt:r diet, important 
factors that especially affect the digestion are the follow- 
ing: I. The hours, order, and frequency of meals. 2- 
Variety in diet. 3. The appetite. 4, The temperature 
of food. 5. Rest and exercise before and after meals, 
6, Emotion. 

1. Order and Frequency of Meals.— It is usually 
customary to fix certain hours for taking of meals ; these 
hours vary with the occupation of the individual. In 
large cities, where the noon hour is taken up largely with 
active business pursuits, evening is selected as the most 
convenient hour for dinner. Sir Henry Thompson states 
that three general systems are in use, according to which 
two, three, or four meals are taken daily. TJie first sys- 
tem, which consi,sLs of two meals a day, is foHowed in 
France and other countries on the continent of Europe. 
A substantial meal, consisting of fish or meat and other of .solid food, is eaten about noon; no food is 
taken before the noon meal, except on arising, when a 
cup of coffee or chocolate and a small quantity of bread 
and butter are taken. The second meal, which is dinner, 
is eaten between 6 and 7 o'clock in the evening. This 
meal is the largest meal of the day, and consists of soup, 
fish, meat, vegetables, salads, dessert, and black coffee. 
The second system, commonly in vogue in England, con- 
sists of four meals daily. The first meal, or breakfast, is 
taken at about 8 A. M., and consists of cocoa, tea or coffee, 
bread, butter, bacon,, or eggs; dinner is eaten be- 
tween 1 and 2 p. M. and consists of soup, meat, fish, vege- 
tables, and pudding; tea is taken at 5 p.m., and supper 
is served ,at 8 p. M., and consists of meat, fish, vegetables, 


and stewed fruits. Dinner is taken in the evening by the 
well-to-do classes, and a substantial lunch is usually taken 
at noon. The third system, practised in this country, 
consists in taking three meals daily. In many towns it 
is customary to dine at noon ; in others, in the evening. 
The usual breakfast, taken between 7 and 8 a. m., con- 
sists of fruits, breakfast food or cereals, eggs, bacon or 
salt fish, tea, cocoa or coffee, and bread and butter. 
Luncheon, eaten between 12.30 and 2 o'clock, consists 
of cold meat or a chop, vegetables, salads, and dessert. 
Dinner, eaten between 6.30 and 8 p. m., is the heaviest 
meal of the day, and consists of soup, fish, meats, vege- 
tables, salads, and fruit. 

The frequency of meals must be regulated according 
to individual conditions. Patients suffering from diges- 
tive disturbances and those who take very small quanti- 
ties of food at a time require nourishment at frequent 
and regular intervals ; whereas, those whose digestion is 
feeble, should allow six or seven hours to elapse between 
meals ; ordinarily the intervals betwen meals should be 
about four or five hours, this being about the time neces- 
sary for complete digestion of a mixed meal in the stom- 
ach. The habit of habitually omitting the noon luncheon, 
so commonly practised by busy Americans, should be 

2. Variety of Diet. — In order thoroughly to satisfy 
the needs of the body the diet must be varied. Although 
a diet restricted to but a few articles of food may contain 
a sufficient quantity of the alimentary principles to sus- 
tain the body nutrition, yet the monotony of such a diet 
becomes so objectionable that it cannot be digested 
thoroughly. With a mixed diet the same person will 
digest a larger proportion of nutrients than with a diet 


composed of a single food material. Certain races re- 
strict the variety of food from religious motives, such as 
the Jewish restriction of ham, pork, and oysters. 

3. Appetite. — Appetite is the desire for food, and is 
dependent upon various conditions. It is controlled by 
the sensation of hunger, and is often induced by the 
sight, smell, and taste of food. Simple bitters or some 
form of alcoholic drink will at times induce this sensa- 
tion. The appearance of badly prepared or improperly 
served food will often dispel the appetite. In children 
the appetite is usually good, whereas in the aged it is 
lessened. Some persons have voracious appetites and 
abnormal craving for food. This is often the in 
diabetic and other conditions, when, at times, the appetite 
cannot be satisfied. 

4. Temperature of Food. — The temperature of 
food when taken is of considerable importance. The 
ideal temperature is that of tJie body, from 98° to 100° F. 
(Uffelman). The limits of safety being between 45° and 
130° F. According to Hutchison, extremes of tempera- 
ture of food are apt to give rise to gastric disturbances, 
such as gastric catarrh. Uffelmann states that a drink 
at a temperature of 122" F. increases the body-tcmpcra- 
ture 0.1 to 0.3" C. It is believed by many that ulcer of 
the stomach, so common in cooks, is often due to the 
taking of too hot foods. 

5. Rest and Exercise Before and After Meals.— 
It is often advisable to rest, but not to sleep, after meals. 
The larger part of the work of the stomach should be 
completed before retiring at night, otherwise the sleep i.s 
apt to be disturbed. About one to two hours .should 
be allowed to elapse between a light evening meal and 
bedtime, and three to four hours between a heavy meal 


and sleep. From personal observations the authors have 
concluded that digestion is improved by rest after meals, 
but impaired by sleep. In many instances a period of 
rest before eating meals is a valuable aid to digestion. 
Violent exercise immediately after meals inhibits diges- 
tion, whereas moderate exercise one or two hours after 
meals materially aids this process. 

6. Pood and Kmotion. — Severe mental strain and 
strong emotion disturb the digestion, and for this reason 
food should not be taken until a period of rest and com- 
posure has intervened. On the other hand, pleasurable 
sensations aid the digestion, and pleasant conversation 
at the table is, therefore, to be recommended. 


Food absorption takes place chiefly in the small intes- 
tine ; in the stomach and in the large intestine it takes 
place only to a limited degree. In determining the de- 
gree of absorbability of food, the amount of the element- 
ary food principles ingested must first be ascertained, 
and the proportion that has not been absorbed determined 
from the feces. The degree of absorbability of a food 
indicates, in a measure, its nutritive value. According to 
Atwater,^ from an ordinary mixed meal an average of 
92 per cent, of protein, 95 per cent, of fats, and 97 per 
cent, of carbohydrates is absorbed in the body. "The 
proportion of the several nutrients which the body re- 
tains for its use are commonly called percentages or 
coefficients of digestibility." The following table, taken 
from Atwater, gives these coefficients of digestibility : 

' Priftciples of Nutrition and N^utritive Value of Fooily Farmers' 
Bulletin No. 142, United States Department of Agriculture. 




Coefficients of Digestibility and Fuel-value per Pound of 
Nutrients in Different Groups of Food-materials. 

Kind of food. 

Meats and fish 


Daily products 

Animal food (of mixed 


Legumes (dried) . . . . 

Sugars f 




Vegetable foods (of mixoJ 

Total food (of mixed diei) 




Per ct. 






Fuel- i I Fuel- 

value Digesti- value 




















Carboh y drates . 

Absorption of Protein. — Eighty per cent, of pro- 
teins are absorbed in the small intestine, and 14 per cent, 
in the large intestine. The proteins of animal food are 
much more completely absorbed than are those of vege- 
table origin. 

Absorption of Fats* — Fats, like proteins, are ab- 
sorbed mainly in the small intestine. This absorption of 
fat is very complete. 

Absorption of Carbohydrates. — Carbohydrates are 
absorbed more completely than either the fats or the pro- 
teins ; consequently, these foods leave but a small residue 
in the intestine. 

As Rubner, Atwater, and others have pointed out, 
foods taken in combination are absorbed more completely 
than when taken alone. Atwater has shown that the 


following proportions of the alimentary principles are 
absorbed when the individual takes a mixed diet : 

Protein. Fat. Carbohydrates. 

Animal foods 98 per cent. 97 per cent. 100 per cent. 

Cereals and sugars .... 85 ** 96 ** 98 

Vegetables and fruits. . . 80 " 90 ** 95 

Food that leaves a small quantity of unabsorbed residue 
in the intestine is not undesirable, in that this residue 
stimulates peristalsis and thus regulates the condition of 
the bowels. 

Absorption of Meat. — Meat leaves a very small 
residue in the intestines — about 3 per cent, of that ingested 
is not absorbed. On this account meat is a most valu- 
able article of food. 

Absorption of Pish. — Fish is very completely ab- 
sorbed in the intestines. According to Langworthy, 95 
per cent, of total solids, 97 per cent, of protein and 90 
per cent, of fat are absorbed. 

Absorption of Milk. — When milk is taken alone, 
only 90 per cent, of the constituents are absorbed ; if 
two liters of milk are taken daily, the loss of dry sub- 
stance, according to Rubner, is 5.7 to 7.8 per cent. ; if 
three liters, the loss is 10.2 to 11.6 per cent. When 
taken with other foods, however, milk is much more com- 
pletely absorbed. 

Infants and children absorb milk much more completely 
than do adults. In childhood milk leaves a residue of 4 per 
per cent., whereas in adults 10 per cent, is not absorbed. 

Absorption of BggS. — Eggs are very thoroughly 
absorbed in the intestine. Rubner states that hard-boiled 
eggs arc absorbed almost as completely as meat, only 
5 per cent, being lost. 

Absorption of Vegetable Foods. — Vegetables are 


more or less completely absorbed in the intestine. If 
the bulk of the vegetables is not too great and the amount 
of ceiiulose is not too large, they will be almost entirely 
absorbed. On account of their bulk and the large pro- 
portions of cellulose which they contain most \'egetables 
are, however, imcomplctely absorbed. The protein is 
here the element that is not absorbed completely, the 
carbohj-d rates and fats undergoing complete absorption. 

Absorption of Cereals. — Such cereals as rice ai-e 
very completely absorbed ; the starch is entirely absorbed, 
and 19 per cent, of the protein is lost. 

Absorption of I,egtuues. — The legumes, such as 
peas and beans, if given in a finely divided state, are very 
completely absorbed. Rubncr finds that even when given 
in amounts of 600 grams daily the loss is but slight. If, 
however, these substances are not given in a finely divided 
state, the loss in proteins is very great^according to 
Rubner, as high as 40 per cent. 

Absorption of Roots and Tubers. — The absorption 
of roots and tubers, such as carrots, potatoes, etc., depends 
upon the quantity of cellulose they contain. Inasmuch 
as the potato contains but little cellulose, it is very com-' 
plctely absorbed. 

Absorption of Green Vegetables. — Most green 
vegetables are very incompletely absorbed in the intes- 
tine. They leave a large residue, which acts as a stimu- 
lant to intestinal peristalsis. 

Absorption of Fraits. — Fruits, like green vegeta- 
bles, are usually incompletely absorbed ; according to 
Hutchinson, 80 per cent, of the protein, 90 per cent, of 
tlie fat, and 95 per cent, of the carbohydrates are ordi- 
narily absorbed. 



This varies necessarily under special conditions. The 
adult requires more food than does the child ; a man at 
work more than one at rest ; an emaciated individual less 
than when he was in robust condition. The selection of 
a proper diet is dependent upon a knowledge of the 
amount of the three alimentary substances — proteins, 
carbohydrates, and fats — necessary to maintain the nutri- 
tive equilibrium and consequently the body-weight. 

Dietaries are formulated by computing the quantities 
of the alimentary principles required under special con- 

Protein. — The quantity of protein disintegrated daily 
by a fasting healthy individual weighing 70 kilograms is 
60 grams ; it is obvious, therefore, that at least this amount 
should always be present in every computed dietary. 
Ordinarily from 100 to 125 grams of protein are con- 
sumed daily. As has been stated elsewhere, i gram of 
fat can replace 2.4 grams of protein or carbohydrates 
and the protein can replace and be partly replaced by the 
carbohydrates and fats. Fats and carbohydrates are, 
therefore, protein economizers. That part of the protein, 
however, required for organization of the body cannot be 
replaced by the carbohydrates or fats. 

Carbohydrates and Pats. — Carbohydrates diminish 
nitrogenous waste and are also sparers of the fats, 240 
grams of carbohydrates being equal to 100 grams of 
fat. If 100 grams of protein are taken and absorbed 
with 600 grams of carbohydrates, the amount of fat can 
be comj)letely protected. Fat alone, however, cannot 
check the waste of the nitrogenous tissues. The inges- 
tion (;f larj^e quantities of fat increases the accumulation 


of fat in the body, and this continues untii the quantity 
administered reaches 300 grams, when no more can be 
digested. Gelatin is a valuable protector of protein. iOO 
grams of gelatin being equivalent to about 35 grams of 
protein or 200 grams of carbohydrates ; it does not, 
however, protect against fat loss so well as do carbo- 
hydrates or fat, 100 grams of gelatin being equiva- 
lent to about 25 grams of fat. Ordinarily about 500 
grams of carbohydrates and 50 grams of fat are consumed 

Protein, Carbohydrates, and Pats in Combina- 
tion. — If fat is combined with the protein, less than half 
the quantity of protein is required to maintain the nitrog- 
enous equilibrium. If more protein, fat, or carbohy- 
drate be supplied under these conditions, fat will be de- 
posited in the tissues. Inasmuch as food contains a vari- 
able proportion of proteins, carbohydrates, and fats 
combined, the food-value must be determined from the 
standpoint of the combined effect of the three alimentary 
principles contained therein. 

In order to supply the requirements of the organism 
a certain amount of potential energy is needed to over- 
balance the amount dissipated in waste and in the pro- 
duction of body-heat. More potential energy is consumed 
during work than when the individual is at rest. The 
following table, computed by Rubner, shows the daily 
heat consumption, in units of heat (calories), in an aduit, 
weighing 65 kilograms : 

During rest in bed .... iSoo calorie.'; ox 28 calories per kilo. 

In repose 2100 " •' 31 " " ■' 

In light work J.103 " "33 " ■■ " 

In moderale work .... 2600 " " 40 " " " 

In hard work 3>oo " " 4^ " " " 


From Rubner's investigations we learn that ^ — 

I gm. of protein =4.1 calories. 

I gm. of fat = 9*3 ** 

I gm. of carbohydrates = 4.1 ** 

It has also been determined that i gram of alcohol 
.equals 7 calories. In other words, the number of grams 
of proteins, fats, and carbohydrates required daily can be 
converted into their calorimetric equivalents, and inas- 
much as we have already seen that the alimentary princi- 
ples can in a degree be substituted for one another (law 
of isodynamics), the daily food requirements can be easily 
estimated in calories of heat. Thus, in order to calculate 
the caloric value of any food in preparing a dietary, the 
number of grams of proteins contained are multiplied by 
4.1 ; the number of grams of fat by 9.3 ; and the number 
of grams of carbohydrates by 4. i ; the total is then ascer- 
tained by adding. Bearing the weight of the individual 
in mind, a dietary can easily be constructed according to 
the following method : 

The quantity of protein consumed daily is 100 gm. X 4' = 4'0 

carlx)hydrates •* ** ^QO •* X 4.1 = 2050 
fats " " 50 " X 9-3 = 465 

it li 


The average number of calories required daily in an 
individual, according to this calculation, is therefore 3000. 

While diet-lists are easily prepared according to the 
method just outlined, it must always be remembered that 
the digestibility and absorbability of food play a most 
important role and are not to be neglected in formulating 
the dietary ; for while a certain food may contain a great 

^Compare Atwater's determinations on p. 14. Dietary computations 
differ slightly, owing to the fact that some use Rubner's standards and 
some Atwater's. 


many more calories than an equal weight of another 
food, yet its relative indigestibility makes it less available 
as an article of diet. For example, while 4 ounces of 
sausage produce J 10 heat calories, 4 ounces of cheese 
520, and 4 ounces of beef only 280, yet the beef is far 
more digestible than either the sausage or cheese, and 
thus more valuable as an article of food. As has been 
aptly said, " We live not upon what we eat, but upon 
what we digest." Therefore, a diet-list giving quantities 
of food principles or calories is useful only as it suggests 
general principles that may be modified to meet individual 
conditions in health and in disease. 

The following table, taken from Mrs. E. H. Richards, 
gives an ideal ration of solid food. For a further con- 
sideration for the method of computing dietaries the 
reader is referred to Mrs. Richards' admirable little work, 
entitled The Dietary Computer: 

An Ideal Ration ef Solid Food.— 


. £. 

If. Richards.) 


























Total ... 





The following table was prepared by the nurses in the 
class in dietetics at the Johns Hopkins Training School. 
It shows the method used in determining the fuel-value 
of the food per capita : 








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Animal foods contain much digestible matter, chiefly 
proteins, a considerable quantity of fat, in some foods 
carbohydrates, and, in addition, water and mineral salts. 
Being thoroughly digested, they leave but little residue 
in the intestine. The various forms of animal foods — 
milk, meat, fish, and gelatin — will now be described. 


Milk, the most important of animal foods, contains all 
the elements necessary for the maintenance of life and 
constitutes a complete food. 

Compositioii. — Milk contains varying proportions of 
each of the four classes of food principles — proteins, fats, 
carbohydrates, and mineral salts. Unadulterated, it con- 
tains from 84 to 90 per cent, of water, varying with the 
quality of the milk. It forms the exclusive diet for 

The principal nitrogenous compound of milk is casein. 
Milk contains, beside casein, lactalbumin, which is similar 
to the serum-albumin of the blood. The total proteins 
average about 3.3 per cent, of the bulk of the milk, or 
about 25 per cent, of the total solids. The fats of milk 
consist of the glycerids of palmitic, stearic, and oleic 
acid. In addition to these, milk also contains several 




other fats in smaller proportions, to which the flavor of 
butter is due. The fat is suspended in the milk in the 
form of minute globules, which gives the milk its white 
color and opacity. Fat averages about 4 per cent, of 
the milk or about 31 per cent, of the total solids. The 
chief carbohydrate of milk is lactose, or milk-sugar. 
Milk-sugar is not nearly so sweet as ordinary sugar, and 
is less soluble in water. In the presence of the lactic 
acid bacillus it is converted into lactic acid, which causes 
the milk to turn sour. Lactose forms about 38 per cent, 
of the total solids. Milk contains about 0.7 per cent, of 

Variations in Milk. — There are wide variations in 
the composition of the milk of different animals. While 
human milk contains more sugar and less protein than 
cow's milk, the fuel value is about the same. Dog's 
milk seems to be the richest ; whereas that which comes 
from the horse is exceeding poor, as may be seen from 
the following table : 

Comparative Composition of Various Kinds of Milk} 



Total solids. 

Kind of milk. 



Pr ct. 












Pr ct. 





Woman . . . 
Cow .... 
Dog .... 
Kwe . . . 
Buffalo . 


float .... 
Llama . . . 


Mare . . . . 







P.r ct. 

12 6 




Pr ct. 




Pr ct. 


II. 2 























1 Konig, Chemie der meiischlichen Ndhrungs- und GenussmUtel, 3d ed., 
vol. i., pp. 267-362. 



Not only is there a wide variation in the milk of differ- 
ent animals, but cow's milk itself is subject to great 
changes in the percentage composition of its ingredients. 
These may be attributed to many causes, the breed and 
condition of the animals, and the food and the care they 
receive being responsible in a great degree for these 
changes. As a rule, a young cow gives better milk than 
an old one, and a well-fed animal yields richer milk than 
one that is poorly fed. 

Adulteration. — Milk is often adulterated by unscru- 
pulous daily men by the addition of water. This is the 
common method of adulteration, and if the water used 
for this purpose is pure, produces no ill effect other than 
to dilute the milk and thereby lessen the percentage of 
its ingredients. Unfortunately, however, water used for 
this purpose is not always pure and is frequently a source 
of contamination. Other methods of altering the quality 
of milk consists in the removal of the fats ; the increase 
in the specific gravity which is produced thereby is coun- 
teracted by the further addition of water and in the addi- 
tion of preservatives. The latter method, while it does 
not detract from the nutritive value of the milk, may, if 
the milk be used regularly, produce deleterious results. 

Digestion of Milk. — When milk enters the stomach 
it is coagulated by the hydrochloric acid and the rennin 
of the gastric juice. These curds, or coagula, consist of 
precipitated casein and a portion of the fat that has be- 
come entangled in the curd. They vary in size and con- 
sistence according to the amount and the dilution of the 
milk taken. The curd that has not been acted upon by 
the gastric juice, together with the water, salts, and car- 
bohydrates that remain, also pass into the intestine, where 
their digestion is completed. Boiling increases the diges- 


tibility of milk, the precipitate being deposited in a more 
flocculent form. If the milk is previously diluted with 
lime-water, barley- water, or one of tJic aerated waters, 
such as Vichy, the curds formed are smaller and softer, 
and the milk often rendered more palatable. Bread or 
crackers added to milk make a good mechanic diluent by 
mingling with it and maintaining a soft condition of the 

Cream. — When milk is allowed to stand for some 
hours the globules of fat rise to the top, and, together 
with considerable milk, are removed as cream. This 
product contains about iS per cent, of fat, and some pro- 
tein and carbohydrates from the milk mi.xed with it. 

Skimmed Hilk. — The residue remaining after the 
removal of cream from ordinary milk is called skimmed 
milk. The amount of fat has been greatly reduced by 
creaming, but the percentage of protein remains almost 
the same. It is more easily digested than whole milk, 
inasmuch as the fat has been removed. 

Butter. — Butter is made from the cream of milk by 
the process of churning, which causes the fat-globules 
that hang suspended in the milk to coalesce, thus form- 
ing a solid mass. A varying proportion of common salt 
is always added to it to enhance its palatableness and its 
keeping qualities. The flavor of butter is due to the 
growth of micro-organisms. Pure cultures of certain 
organisms are now utilized to ripen butter and so impart 
a constant flavor. 

On account of the ease with which it is digested, butter, 
when fresh, is one of the most valuable fatty foods. The 
rancidity which occurs when butter is kept too long seems 
to be due to the casein, which, on undergoing fermenta- 
tion, liberates fatty adds. Butter is best preserved by 



keeping it at a low fcniperature, and good results are also 
obtained by salting. 

Buttermilk. — Buttermilk, which is formed diLring the 
manufacture of butter, is another milk derivative of no 
little importance. It is used extensively as a beverage, 
and is highly nutritious and easily digested. It contains 
the casein of the milk in a finely coagulated form. 

Cord and Whey. — Curd is the coagulated casein of 
milk. This coagulation may be brought about by rennin, 
a ferment found in the gastric juice, or by such acid sub- 
stances as lemon-juice, white vinegar, etc. Whey is the 
fluid portion of the milk remaining upon the coagulation 
and removal of the casein. Whey is an excellent drink 
and food in those cases in which milk is not well 

Cheese. — Cheese is made up of curd and a certain 
proportion of the fat of milk. Cheeses vary in compo- 
sition and consistence according to their preparation. 
Some cheeses are soft, while others are hardened into 
cakes by pressure. The flavor of cheese is due to the 
growth of certain micro-organisms during the ripening 
process. The harder cheeses keep much longer than the 
softer ones. 

Cheese is a nutritious and agreeable food, but it is often 
difficult of digestion. The harder cheeses are much more 
indigestible than those of soft consistence. Like milk, 
cheese may contain certain poisonous substances, due to 
organisms that enter the milk ; of these, one of the most 
common is tyrotoxicon. Poisoning may follow the eat- 
ing of such cheese. 

Ktimiss, Kefir, and Matzoon.— Kumiss is a fer- 
mented drink prepared both by lactic acid and alcoholic 
fermentation. For many centuries it has been made from 





mares' milk by the natives living near the shores of the 
Caspian Sea. 

Kumiss is an acid, effervescing drink, and contains 
a very small proportion of alcohol. It is very easily 
digested, being much more digestible than milk. 

Kefir resembles kumiss and is often used as a substitute 
for it. It was originally made in the Caucasus from cows' 
milk fermented. 

In matzoon lactic acid is produced by fermentation 
with a ferment obtained from Syria. It i.s thicker than 
kumiss and does not contain alcohol. 

Kumiss, kefir, and matzoon are agreeable forms of 
milk foods, are very easily digestible, and are especially 
useful in those cases in which milk can not be taken or 
is not well borne. 

Modification and Preservation of Milk. — Oon- 
tamination of Milt. — An important source of contamina- 
tion of milk is through disease of the udder of the cow 
or carelessness in handling this organ. Cows are too 
often kept in filthy stables, from which dust and excre- 
mentitious matter find their way into the milk-pail. The 
germs of disease that do not get into the milk in the 
stable frequently do so through the agency of the bottles 
or cans in which the milk is shipped, and which are often 
unclean or cleansed with polluted water. 

Cows should not be allowed to eat the dry leaves on 
which they are mostly bedded, their color, odor, or 
even poisonous properties be imparted to the milk. Sour 
milk and milk from poor cows is unfit for food and should 
not be used. 

At times tuberculosis or inflammatory conditions due 
to micro-organisms may exist either in the udder of the 
cow or in some distant organ, and may be so slight as 


not to attract the attention of the milker. Among the 
pathogenic germs that may thus gain access into the 
milk are the bacilli of typhoid fever, tuberculosis, diph- 
theria, and cholera. On entering the milk these organ- 
isms continue to grow, and in a short time multiply enor- 
mously. In addition to pathogenic organisms, other 
micro-organisms which produce souring, but are other- 
wise harmless, may gain access to the milk. 

At Bumside Farm, Green Spring Valley, Md., the farm 
of Mr. Samuel Schoemaker, from which the Walker- 
Gordon milk sold in Baltimore is obtained, the following 
precautions to prevent contamination are taken : The 
dairy is managed by trained persons, and is being con- 
stantly inspected by experts in their respective depart- 
ments. The number of bacteria in the milk is recorded 
daily at the laboratory. The cows are tested for tuber- 
culosis at frequent intervals. The stables are kept in a 
thoroughly hygienic condition, the floor and walls being 
cemented and well scrubbed each day. The milker is 
required to scrub his hands thoroughly before milking 
and to clothe himself in a white sterilized suit. The cows 
are thoroughly groomed one hour before milking. The 
cows are milked into special milk-pails, so arranged as to 
prevent the dust from entering. The first milk drawn, 
which usually contains any germs that may have entered 
the milk-ducts, is discarded. The pails, bottles, and other 
apparatus are sterilized at a temperature of 2 1 2° F. The 
milk is passed from the pail into cans and is then taken 
to the milk-house, where it is strained through sterile 
cotton into a sterilized cooling-tank, after which it is 
bottled, corked and sealed. A guarantee as to the purity 
of the milk goes with each bottle. 

Modified liilk. — Modified milk is prepared from the care- 



s set aside for producing milk that is to 

y selected cows s 

be separated and recombined according to the prescrip- 
tion of the physician. The separation of tlie millv and 
cream is accomplished by means of the centrifugal ma- 
chine. The separated milk and cream, as well as the 
whole milk, which has been cooled at a temperature 
of 40° F. or below, are then sent to the city laboratorj-, 
where the definite percentages of 
cream and modified milk are re- 

Sterilization and Pasteurisation 
of Milk. — Milk is sterilized by 
boiling ; sterilization destroys all 
micro - organisms. The disad- 
vantages of sterilization are in a 
measure overcome by Pasteuriza- 
tion. By this process the milk is 
kept at a temperature of 70° C. 
(rs8° F.) for from twenty to thirty 
minutes; thus most micro-organ- 
isms are kiiled, the spores, how- 
I ever, not being destroyed, al- 
though their growth is inhibited. The taste of the milk is 
not so markedly altered as in sterihzed milk, and it is .said to 
be more easily digestible for patients suffering from gastro- 
intestinal disturbance.?. It does not, however, keep so 
long, and sours in one or two days. While bacteria are 
destroyed by sterilization, their spores, which are also 
present, are not killed, and if kept at ordinary tempera- 
ture they continue to increase largely in n umber and thus 
render the milk unfit for use. The disadvantages that 
accrue from sterilizing milk are manifest in the constipa- 
ting effect and in its altered taste. As the result of steril- 



ization various chcmic changes take place: the lactal- 
bumin is somewhat coagulated, the casein is so changed 
that it is less easily acted upon by the rennin, and part 
of the lactose is changed into caramel ; some of the sol- 
uble salts are converted into insoluble ones. A large pro- 
portion of these changes are not yet thoroughly under- 
stood. According to Holt, the greatest objection to 
sterilizing milk lies in the fact that many infants fed upon 
it for long jK-riods of time are apt to suffer from scurvy ; 
he reports that at least a dozen of such cases have come 
under his notice. I^y Pasteurization all these difficulties 
are overcome, and from 98 to 99 per cent, of all micro- 
organisms, including the bacillus of typhoid and of tuber- 
culosis, arc destroyed, although the spores are not killed. 
Sfiecial care must be exercised in Pasteurizing milk, and 
as soon as it is Pasteurized it should be placed on ice. 

Ih'occss of Sterilization. — By means of the Arnold 
sterilizer milk can easily be sterilized in small bottles in 
(juantities just sufficient for each feeding. Sterilization 
may also l>e effected simply by exposing the bottles in a 
vessel that is tightly covered and opened at the bottom, 
and allowing the steam from boiling water to enter from 
hrlow. The milk is then kept at a temperature of 212° 
V for one hour. 

An rxcrllrnt apparatus for Pasteurizing milk is that 
(leviMMJ by I'^reeman. "This appanitus consists of two 
p.ut*i. a pail lor the water an<I rcreptacle for the bottles 
t»r mills, riir pail is a simple pail with a cover; there is 
a ^:tot»\r rsttMulin^ an»un<l the pail to indicate the level 
to whiih it is t»» be filled with water, ami supports inside 
for the rrreptat le for the bottles of milk tt> rest on. The 
in rpt.u Ir fiu the bottles (»f milk consists of a series of 
hi»llow tww lyliudets fastened together; this fits into 


the pail, so that the lower inch of the cylinders is im- 
mersed in the water. This receptacle has two sets of 
horizontal supports, the upper set continuous around 
the receptacle, for use while the millc is being heated ; 
the lower interrupted set is used for raising the receptacle 
during coohng. Such receptacles are made for ten six- 
ounce bottles, seven eight-ounce, three pint and one half- 
pint bottles, and two quart bottles. There is also a large 
apparatus for the use of hospitals or public institutions 


r eight- 

which has a receptacle for forty-three six-c 
ounce bottles." 

Since heating does not destroy the spores of bacteria 
nor the toxins in milk, it is essential that the milk be as 
fresh and as free from disease germs as possible before 
sterilization is undertaken. A question frequently asked 
is whether all milk should be sterilized before using. The 
milk usually sold in large cities is, as a rule, transported 
from considerable distances, and is often not consumed 
for from twenty-four to forty-eight hours ; it is thus apt, 
especially in hot weather, to be contaminated with micro- 
organisms. Boiling is the only safe method of destroy- 
ing such organisms. In the past few years there has 
been a growing tendency, especially in large cities, toward 


the establishment of dairies, such as the Walker-Gordon 
laboratories, from which perfectly pure milk may be ob- 
tained, thus obviating the necessity for sterilization. 

Predigestioii of Milk.-;-Milk may be partly or wholly 
predigested in order to render it more easily digestible for 
individuals suffering from gastro-intestinal disorders. 
This process is readily accomplished by adding an active 
preparation of pepsin to acidulated milk and allowing the 
fermentation to proceed under the influence of heat at the 
body temperature by immersion in hot water. During 
this fermentation the casein is partly or completely con- 
verted into albumoses. If the process is allowed to con- 
tinue too long the milk becomes bitter. For this reason 
it is ordinarily removed from the hot water after a few 
minutes and is placed upon ice, which prevents further 
fermentation. In order to predigest milk in alkaline 
solution pancreatin is substituted for pepsin ; pancreati- 
zation of milk has now largely replaced peptonization. 
In order to effect pancreatization of milk, Fairchild*s 
peptonizing tubes are ordinarily employed. Where the 
taste of pancreatized milk proves objectionable, the addi- 
tion of carbonated waters or of small quantities of coffee 
may render it more palatable. 

The digestibility of milk may be increased by the addi- 
tion of hot or cold water, carbonated waters, such as 
Vichy or ApoUinaris, lime-water, oatmeal, or barley- 
water, or farinaceous foods, such as arrowroot or flour; 
occasionally small quantities of salt or sodium bicarbon- 
ate are helpful. 

Humanized Milk.— By the term " humanized milk " is 
meant cows* milk that has been so modified as to approach 
human milk as nearly as possible. This is accomplished 
by decreasing the casein and increasing the fats and sugars. 


Condensed Milk. — Condensed milk is manufactured 
by evaporating cows* milk in a vacuum until it becomes 
thickened and jelly-like. It is used largely among the 
poorer classes for infant-feeding. Although they appear 
to fatten and thrive on it, infants fed on this form of milk 
are often poorly developed and are liable to develop 
rickets. The two principal forms of condensed milk are 
those containing comparatively little sugar and those to 
which cane-sugar has been added. The first form con- 
tains from 1 5' to 18 per cent, of milk-sugar; the latter 
from 15 to 18 per cent, of milk-sugar and from 36 to 
40 per cent, of cane-sugar. Condensed milk is most 
easily digested, but is apt to contain too little fat ; the 
unsweetened condensed milks are the most satisfactory 
forms for infant-feeding. 


Eggs, like milk, form a complete food — that is, they 
contain a proportion of each of the fundamental food 
elements necessary for the preservation of life. Eggs 
and milk are the only complete food products furnished 
by the* animal kingdom. 

The eggs of the hen are consumed in largest numbers, 
but those of the duck, turkey, guinea-hen, and of some 
wild fowl are also eaten. The eggs of the domestic 
fowls vary in size and appearance, but their composition 
is about the same. 

The shell of a hen's egg constitutes 1 1 parts, the white 
57 parts, and the yolk 32 parts of the entire weight of 
the egg. The table on page 48 shows the composition 
of hens* eggs, cooked and raw. 

As may be seen from that table, the egg contains 
mainly protein and fats, in addition to water and mineral 


matter. The white and the yolk differ in composition, 
the white containing more protein and water than the 
yolk, and scarcely any fat and ash ; whereas the yolk 
contains considerable fat and ash. The wh'tc is said to 
be pure protein. 

The flavor of the egg is dependent in a large measure 
upon the food eaten by the laying hen. Fresh eggs, as 
is well known, have the finest flavor. 

If thoroughly macerated, hard-boiled eggs are as 
digestible as soft-boiled ones. With some persons eggs 
in any form are indigestible, and produce unpleasant 
eructations, nausea and headache. 

Raw eggs are best taken directly from the shell, or 
they may be combined with milk broths or with coflte. 
In various diseases accompanied by loss of flesh and 
strength raw eggs in large numbers are prescribed, as 
many as 24 eggs being given in twenty-four hours. 

Egg'^lbmnin is best absorbed when eaten raw and 
properly diluted. Its palatability may be increased by 
flavoring it with sherry wine, orange-, lemon-, or grape- 
juice, or by serving it in cream, cocoa or cofllee. 

Egg:-nog is prepared from niiik and eggs, flavored 
with some alcoholic drink, and sweetened with sugar. 

Meat forms the flesh or muscular part.'i of the body. 
It is one of the important articles of food and is the 
chief source of man'.s protein supply. Meat may be 
eaten raw or cooked. Raw meat, when well ground up, 
s very easily digested. 

Meat is composed of muscle-fibers held together by 
connective-tissue bands; between the muscle-fibers are 
bits of fat. As ordinarily seen meat contains muscle- 



tissue, connective tissues, blood-vessels, nerves, and 
lymphatics, together with a varying amount of fat. The 
more fat there is in meat the less water and nitrogenous 
matter does it contain, and vice versa. Cooking has the 
effect of rendering the connective tissues soluble, thereby 
causing a separation of the muscular fibers, allowing the 
I digestive secretion to mingle more thoroughly with them. 
' Cooking also enhances the flavor and appearance of 
the meat, but, on the other hand, causes a loss in fat 
and extractives. Cooking likewise destroys the micro- 
organisms that may be present in the meat and thus 
renders it more wholesome. 

Digestibility of Meats. — The digestibility of meat 

is governed by many conditions ; The age at which the 

, animals eaten were killed, the length of time the meat is 

[ kept before eating, the care bestowed upon the animals 

during life, and the methods of preparing the meats for 

the table. Meats are most easily digested when stewed ; 

I frying renders them indigestible. 

Beef. — The composition of beef varies greatly, espe- 

l dally in regard to the amount of fat and water it contains. 

I An ox from three to five years old supplies the best 

\ beef. The meat of a verj' lean animal will contain about 

75 per cent, of water and about 2 per cent, of fat. 

Meat Preparations. — Numerous meat preparations, 
I 'both sohds and liquid, are now on the market, the aim 
I being to produce a concentrated food that will be readily 
I digested. The different beef-juices have but slight nu- 
I tritive value, most of them containing only 4 or 5 per 
I cent of protein ; their chief value lies in the fact that they 
I stimulate the appetite. 

Bouillons. — Bouillons are prepared by cutting meat 
I into small bits, heating slowly in water for a time, and 



then boiling it quickly. The fluid thus produced has a 
very agreeable flavor, but its nutrient value is exceed- 
ingly small. 

Beef-extracts. — Beef-extracts are concentrated bouil- 
lons that are to be diluted at the time they are taken. 
Their nutritive value is about the same as that of 

Beef -juice. — To produce a nutritious liquid-beef 
preparation, the meat should be broiled slightly and then 
cut into small pieces and pressed through a lemon- 
squeezer or a meat-press. In this way considerable 
quantities of protein, in addition to the salts and extrac- 
tives, are obtained. The beef-juices sold on the market, 
such as Valentine's, are prepared by subjecting the meat 
to a strong pressure. These preparations contain from 
5 to lo per cent, of protein. 

Meat Powders. — The nutritive value of these prepa- 
rations varies greatly. Those most frequently used are 
a number of peptones, Somatose, and the Mosquera 
" Beef Meal." 

Meat-jellies. — Meat-jellies are frequently given to 
invalids and are an agreeable means of a.dministering 
protein food. Although they do not entirely replace the 
protein in the tissues, they produce a considerable quantity 
of energy. 

Veal. — Veal is tough and indigestible, especially when 
obtained from the animals that are killed too young. It 
differs considerably in flavor from beef As in many 
persons veal has a tendency to produce indigestion, it is 
to be avoided in all cases of digestive debility. 

Mutton. — Mutton is considered more digestible than 
beef by English writers, probably because in England 
the average mutton is more tender than that obtained in 


the United States ; the beef, however, is inferior to that 
raised in this country. 

I/amb. — Lamb, when of the right age and tenderness, 
is as digestible as beef or mutton. 

Venison. — Unless obtained from young animals, 
when it is tender, highly-flavored and short-fibered, 
venison is apt to be difficult of digestion. 

Pork. — Pork is the most indigestible of all meats, 
on account of the large percentage of fat that it contains. 

Ham and Bacon. — Ham and bacon are both more 
digestible than pork. In some parts of Germany ham 
plays quite an important part in invalid dietaries. Bacon 
is used largely as an army ration. When cooked crisp, 
thin slices of bacon are easily digested. 

Rabbit. — When young, rabbit meat is quite digest- 
ible, but it is usually omitted from diet-lists. 

Fowl. — Chicken is one of the most digestible and 
agreeable varieties of meats. The meat of young pi- 
geons also is especially digestible; that of ducks and geese 
contains too much fat. 

The flesh of game is easily digested, the meat of the 
breast being best adapted for invalid use. 


The different kinds of fish vary widely in their nutri- 
tive and digestive qualities. For example, the flounder 
and the oyster are much easier of digestion than those 
that contain a large amount of fat, like the salmon and 
the herring. Eels contain the greatest proportion of fat, 
which may reach 28 per cent. White-fleshed fish, as a 
rule, contain little fat. 

The table, compiled from Atwater and Langworthy, 
gives the chemical composition of some animal foods : 


Itruwn-ibcllid eg 

f.«, , , : ;::;::; ^; 

Fknli , . . 

i!:? ' ^i ll;! I ii:! , : : I IS ; 














ID. J 









S7i^^" ""''■"' 


Httddocli'.dreMtd,', . . 
MuUtnii, dmud .... 





Mickcrcl, Sjuniih, wbulc 
Pnch.whlu, dmed , . 



PoaipaiiD. dmscd . . . 




Trout, brook, drejacd , 
Turbol dniKd .... 

MKlit«l."No. .."ulled 


Herring. Mltcd, «nok«l. and d.ied 


H.ddock;™c.k«J, canntd . . . . 


,.j .., 



GcnctBl BvcrsE< of moUusks <eiclu- 


*ri ;:: n o^ sj r,: 

Trrrafiu. tartlf, etc. 

Te^pln. in .hell 

Cr«n .unit, in (hell 

7,7 . «.., 1 4. ^ o. 



J i ,^^' „ 1 „, ■ „„ 



All fish are best in season ; out of season they lose 
their flavor and have a diminished nutritive value, and 
in some cases develop an offensive odor. 

On account of the rapid changes they undergo by way 
of decomposition, fish should always be eaten in as fresh 
a condition as possible. Various methods have been 
resorted to with a view to preventing these changes. 
There are many modern contrivances for preserving fish, 
and drying, smoking, pickling, salting and canning are 
practised on a large scale. 

Crustaceans. — The most popular of the crustaceans 
are the crab and the lobster. They are highly nutri- 
tive, but at the same time highly indigestible. In some 
persons the crab and the lobster are especially apt to 
bring on nausea, vomiting, and other and more distress- 
ing conditions. 

Shell-fish. — Oysters, clams and mussels are the 
forms of shell-fish chiefly eaten. Oysters, when eaten 
fresh and raw, constitute the most digestible animal food, 
but when cooked their digestive value is much lowered. 
The soft part is proportionately larger and more nutri- 
tious than the corresponding portion of the clam. The 
hard or muscular portion is tough and rather indigest- 
ible, and is best omitted from invalid dietaries. Oysters 
should never be fried for the sick. Oysters have in 
many cases been the carriers of typhoid fever, and many 
persons have been infected in this way. 

Clams are a popular article of diet and are as agree- 
able to most palates as oysters. Mussels are consumed 
chiefly by the poorer classes in the seaport towns of 

; • •• 2 • • • 

• • • • •• • ••• 

#*••• • • \ • 

* • • • • •*•• 

• • • 

• • • • • • 

• • •• •• 
• • • • • • • 

• •• • • • • 

• ••• •• ••• 



Vegetable foods differ from animal foods especially in 
that they contain a large proportion of starch and sugar 
and comparatively a small amount of protein. 

Vegetables do, however, contain a certain amount of 
proteins and fats. 

Carbohydratesof Vegetables.— These arc starches 
and sugars. Starch is found in all plants, and is con- 
verted into dextrin by means of dry heat or by cooking. 
The starch-granules in vegetables are held together by a 
cellulose framework. Cellulose is a carbohydrate, but 
is very insoluble; it can be utilized as a food only when 
young ; when old, it is resistant and cannot be digested 
and hinders the digestion of the starches enveloped 
by it. 

Protein in Vegetables.— These proteins belong 
mainly to the globulins. 

Extractives in Vegetables. — There is a consider- 
able amount of extractive matter in certain vegetables, 
such as asparagus, which is not utilized in the body. 

Fats in Vegetables. — The fats in vegetables are 
chiefly in the form of oils. In addition, vegetables con- 
tain a considerable amount of water and salt. The 
amount of water varies between 70 and 90 per cent 
The main mineral constituents are the salts of potash 
and soda united with organic acids. 

Digestibility of Vegetables.— The digestion of 
vegetables takes place mainly in the intestines. Owing to 
the greater bulk of vegetable food and to the cellulose 
that surrounds vegetable cells and thus prevents the 
ready access of the digestive juices, vegetable food is not 
so easily digested as animal food. For convenience of 


description the following classification of vegetable foods 
has been adopted : 

1. Cereals. 5, Fruits. 

2. Legumes. 6. Nuts. 

3. Roots and tubers. 7. Fungi. 

4. Green vegetablus. 8. Lichens. 


Cereal.s are the most important food-pro duct.s derived 
from the vegetable kingdom. Of this class of foods 
those in commonest use are wheat, corn, rye, oats, bar- 
ley, rice and buckwheat. The cereals are eaten chiefly 
after having been ground into flour or meal. Flour 
is most commonly made from wheat and rye ; whereas 
corn and oats are the chief sources of meal. 

Wheat is the most important source of flour, owing 
to the fact that it can be raised in any temperate climate 
and yields the best flour at the least expense. It is rich 
in solids and contains little water. 

Flour is made by grinding the grain of the various 
cereals. Although flour is made chiefly from wheat and 
rye, barley, oats, maize, etc., are aiso manufactured into 

Bread is made by adding to flour a definite proportion 
of water, a little salt, and the leavening agent. The 
mixture or dough is then kneaded, either with the hands 
or, better, with a spoon. In the large modern bakeries 
the kneading is done entirely by machinery. After this 
the dough is set aside for a number of hours, during 
which time fermentation takes place. It is then molded 
into loaves and baked. The leavening is dependent upon 
the action of the yeast on the starch, some of which it 



converts into sugar, and then into alcohol and carbon 
dioxid gas. The gas causes bubbles to appear through- 
out the dough and renders it light and spongy. During 
the baking process the yeast germs are killed and the 
alcoho! and carbonic-acid gas are driven off Hot or 
fresh bread, when masticated, forms a tenacious, doughy 
mass, and hence is not so digestible as stale bread. 

Biscuits, pastries, and puddings are made by adding to 
the flour varying quantities of eggs, sugar, milk, butter, 
fruit, flavoring extracts, etc. 

Rice constitutes the staple food of manyofthepeoples 
of the Orient. It is grown chiefly in Asia, but is also 
raised in some parts of Europe. In this country rice 
culture is confined chiefly to South Carolina. Rice con- 
tains a large proportion of starch in very digestible form, 
but is comparatively poor in other constituents. 

Oatmeal is used to the best advantage in making 
porridge; owing to its lack of gluten it makes only the 
poorest kind of bread. What is known as Scotch groats 
is prepared by freeing the grain from its outer husk. 


Of the legumes, the pea and the bean are the most 
important food-products. 

The legumes contain a liberal proportion of protein 
(legumen), carbohydrates, and a little fat, besides a large 
amount of water. Although legumes contain a propor- 
tion of protein in excess of that of meat, a large amount 
of fat, and considerable starch , they are less easily digested 
than animal foods. They contain much indigestible 
fiber (cellulose), and are also very liable to produce fer- 
mentation, and in this way occasion flatulence and gas- 
tro- intestinal distress. The digestibility of the legumi 

id gas- ^m 


depends largely upon the manner in which they are pre- 
pared and the amount that is eaten. A large portion of 
the legumes ordinarily eaten is imperfectly absorbed by 
the intestine. 

Beans form one of the oldest forms of vegetable 
foods, having been cultivated by the ancient Greeks, 
Romans, and Egyptians. The numerous varieties used 
for food have all been improved by cultural methods. 

There are several varieties of peas, the most important 
being the field- and the garden-pea. The former is gen- 
erally used for fodder; but one variety, the Canadian 
field-pea, is grown for table use. There are many varie- 
ties of the garden -pea. 

The lentil is but little used in this country. The chief 
supply of lentils comes from Egypt, very few being grown 
in Europe. They form a highly nutritious food. 


Roots and tubers constitute another class of vegetable 
foods that are of great importance. They contain both 
starch and sugar, and to these constituents is due their 
chief value as a food. On account of the small propor- 
tion of protein and the large amount of water they con- 
tain, they arc inferior in nutritive value to both legumes 
and cereals. 

The potato is, for several reasons, the most important 
member of the group. It is a tuber or thickened under- 
ground stem of the- Solanum tuberosum. It grows 
equally well in a variety of soils, and when properly 
cooked is easily digested. 

The sweet potato contains more water and sugar 
but less starch than the white potato. When boiled, it 



usually becomes mealy, but is often converted into a 
stringy, sodden mass that is difficult of digestion. 

The beet contains a very large percentage of starch 
and sugar. It is raised extensively for the sugar in- 
dustry, and is also largely employed for making salads 
to lend variety to the diet. 

Carrots, when young and tender, form a very nutri- 
tious food and are greatly relished by many persons. 
They contain from 85 to go per cent, of water. 

Parsnips, when boiled long enough, form a good 
food; like carrots, they contain a large proportion of 
water and a considerable amount of sugar. 


The green vegetables are valuable not only on account 
of the amount of nutriment present in them, but for the 
variety and relish they give to the diet. They contain a 
large amount of salts and have valuable antiscorbutic 

Cabbages contain a considerable quantity of sulphur, 
and on this account are apt to cause flatulence; where 
digestion is good, however, they are considered a whole- 
some form of food. 

Cauliflower is the most digestible member of the cab- 
bage family. It may be eaten either as a salad or boiled 
and served with a milk-sauce. 

Spinach is a popular form of vegetable and is used 
to a great extent. It is valuable chiefly for its laxative 

I^tttice is the most important representative of a group 
of vegetables u.sually eaten raw. It is made into salad 
and dressed with vinegar. The various cresses also 
belong to this class. 


Celery, which is usually eaten raw, is stringy and has 
scarcely any nutritive value. Cooked in milk it forms a 
wholesome and digestible article of food. 

Tomatoes are eaten both raw and cooked, and are 
refreshing, generally liked, and easily dige.sted. They 
are used to flavor broths and are valuable for canning 
purposes, inasmuch as they retain their flavor better than 
most vegetables. 

Asparagus is highly esteemed for its delicate flavor. 
It is easily digested, even by invalids. It has a slightly 
diuretic action, and imparts a most oflensive odor to the 
urine, which persistsfor from twelve to twenty-four hours. 

Vegetarianism. — It will not be out of place here to 
point out the disadvantages of an exclusive vegetable 
diet. Vegetarians are those who subsist almost entirely 
upon vegetables, cereals, fruits, and nuts; exceptionally 
milk and eggs are added to their diet-list. It is quite 
possible, by the eating of vegetables alone, to supply all 
the food constituents — carbohydrates, fats, and proteins — 
that are required by the body. Proteins are obtained 
partly from vegetables, milk, and eggs; those derived 
from vegetables, however, are digested with much more 
difficulty and absorbed to a much slighter degree than 
those derived from animal food. Persons subsisting on 
a purely vegetable diet for any great length of time are 
apt to lose strength, as well as physical and mental vigor 
and endurance. laborers are unable to perform the 
same amount of work they could accomplish on a diet 
containing animal food. While vegetables contain large 
proportions of proteins, in order to supply them in suffi- 
cient amount very large quantities must be eaten. This 
overfeeding is apt in many instances to produce digestive 
disturbances, particularly in those suffering from gastro- 


btestinal disorders. A purely vegetable diet, if persisted 
fin, is also said to lessen the power of resisting disease. 


Fruits arc of little value as nutriment, and are useful 
I mainly to give variety to the diet. They are used ex- 
k.iensively as flavoring agents. The chief nutritive con- 
Istituent of fruits is sugar, and they also contain a small 
liamount of nitrogenous matters, cellulose, starches, 
[-organic acids, and a vegetable jelly called pectin, which 
I. causes fruit to gelatinize when boiled. The sugar present 
■ in fruit is mainly fruit-sugar, or levulose, but some fruits 
P.contain, in addition, considerable cane-sugar. In general, 
f fruits contain a large amount of water. The niineral 
elements of fruit consist of potash, united with tartaric, 
dtric, and malic acid.s. The flavor and odor of fruits 
k are due to the presence of essential oils and compound 

The digestibility of fruits varies with the kind of fruit 
Eeaten and its mode of preparation ; stewed fruits are 
B-more easily digestible than raw fruits. Among the 
more easily digestible fruits are oranges, lemons, grapes 
B.and peaches ; raw apples, pears and bananas are some- 
EWhat less digestible. 

Oranges and lemons are used in invalid dietaries, their 
Huice allaying thirst very effectively. 

Apples are wholesome, digestible and slightly laxa- 

Pears are, as a rule, more easily digestible than apples. 

Peaches are wholesome and digestible. They contain 
ESS sugar than most fruits. 

Bananas are the most nutritious of the raw fruits. 

Grapes contain a large amount of water and consid- 


erable sugar. When thoroughly ripe they are very 

Raisins are prepared by drying grapes, the white ones 
being those most used. 

Plqms and green gages are quite digestible when fully 

Prunes are dried plums. They contain much sugar 
and are markedly laxative in their effect. 

Olives have a bitter taste and are eaten chiefly as a 
relish with salads. Their nutritive value is due to the 
oil they contain. 

Strawberries are very wholesome unless taken in excess. 

Currants, gooseberries, raspberries, huckleberries, mul- 
berries," and a few other berries a contain considerable 
amount of free acids. They have slightly laxative prop- 

Melons contain over 95 per cent, of water and about 5 
per cent, of other constituents ; they are considered indi- 

Figs and dates contain large quantities of sugar. The 
value of the date as a food to the Arab is well known. 


Nuts contain a large quantity of fat and a somewhat 
larger proportion of protein. They have but little food 
value and are eaten mainly as a dessert. The average 
composition of nuts is : 

Water I- 4 per cent. 

Protein 6-15 

Fats 40-50 

Carbohydrates 6-10 

Owing to the large amount of cellulose as well as the 
large proportion of fat they contain, nuts are not easily 



digested. The dense cellulose framework which makes 
nuts so indigestible can be destroyed by grinding, and 
tims the nut made more easily digestible; such prepara- 
tions as Nuttolene, Bromose, and Nutmeal, of the Battle 
Creek Sanitarium Company, are prepared in this way. 

Almonds contain much fat, but no starch and very 
little sugar. 

Chestnuts contain a small amount of oil and a large 
amount of carbohydrates. 

Walnuts contain a large proportion of protein and fat, 
but are quite indigestible. 

The cocoanut contains a large amount of fat and car- 


Fungi. — The three varieties of fungi usually eaten 
are the mushroom, truffle, and morel. 

Mushrooms are prized chiefly for their agreeable taste. 
They possess some nutritive value. 

The truffle grows underground and is especially sought 
for on account of its delicate flavor ; the black variety 
is considered the finest. 

TJie morel is usually obtained from France. It is sold 
in the dried state and is utilized chiefly for seasoning 

Many fungi are poisonous, and these are usually dis- 
tinguished by a disagreeable odor and taste, and other 
peculiarities in structure, etc. 

Algse.— The only one of this group that is utilized as 
food is Iriitli moss, 

Ifichens. — The only important lichen used as a food 
is Iceland moss. 




The following table, taken from Atwater, gives the 
chemic composition of the most common cereals : 



Buckwheat . . . 
Com (maize) . . 
Kafir corn . . . 




Wheat ; 

Spring varieties . 

Winter varieties 



Per ci. 

Per ci. 



1 0.0 





1 1.8 








Per ci. 

Per ci. 




















Per ci. 






The following table, taken from Hutchison, gives the 
chemic composition of some fruits : 


Apples . . 
Pears . . . 
Apricots . . 
Peaches . . 
Green gages 
Plums . . . 
Cherries . . 
Currants . . 
Cranberries . 
Grapes . , 
Bananas . . 
Oranges . . 
Ivcmons . . 
Pineapples . 
Dates, dried 
Figs, dried . 
Prunes, dried 
Raisins . . 


Per ci. 






















1. 10 
1. 00 
1. 00 
1. 00 
1. 00 

1. 00 



Per ct. 












Per ct. 



1 0.0 














Per ci. 












Perci. Perct. 















































The following table, compiled from Atwater, Abel, and 
Hutchison, gives the chemic composition of some vege- 
tables : 


Fresh legumes : 


Sugar peas or string-peas 

Shelled kidney beans . . 

Shelled Lima beans . . 

Shelled peas 

Canned string-beans . . . 
Canned Lima beans . . . 
Canned kidney beans . . . 

Canned peas 

Dried legumes: 

Lima beans 

Navy beans 


Dried peas 


St. John's bread (carob 



Sweet potatoes 








Vegetable marrow .... 

Brussels sprouts 











Per ci. 








































Perct. Perct. 

















































.' hydrates. 


Per ct. 

Per ct. 























«> . 

9 0) = 

^B o 




















Sugars arc carbohydrates that contain hydrogen and 
oxygen in a proportion to form water. Sugar is one of 
the most valuable and popular forms of food. This 
popularity is due not only to its nutritive value, but also 
to its pleasant taste. According to Abel, 86 pounds of 
sugar per capita were consumed in England in 1895 and 
64 pounds in the United States in the same year. From 
7.000.000 to 8,000,000 tons are consumed annually in 
the different countries of the world. The principal 
variety of sugar in use is cane-sugar ; besides this, 
grape-sugar, fruit-sugar, and milk-sugar also enter into 
the composition of our foods. Sugar is obtained in a 
fluid state, as in honey, as well as in crystalline form. 

Sugar is very fattening and at the same time is also a 
great source of muscular energy. Most of the ill effects 
attributed to the use of sugar arc due to the fact that 
more than one-quarter of a pound is consumed daily 
(Hutchison); this amount maybe taken with impunity 
by the healthy adult, but if more be taken, it will be 
excreted rapidly by the kidneys, giving to a condi- 
tion known as temporary or alimentary glycosuria. 

Sugar can be absorbed only as dextrose and as levu- 
lose, all varieties of sugar being converted into these 
forms before they are absorbed. In strong solution 
sugar irritates the mucous membrane of the stomach 
and is apt to undergo fermentation, and thus produce 
gastro-intestinal distress. 

Cane-sugar is the most common and most exten- 
sively used form of sugar. It is made chiefly from 
and from the sugar-beet. When pure, it 
J mass of white crystals. 



Oandy contains a large amount of sugar, besides but- 
ter and other fats, starch, nuts, flavoring extracts, etc. 
The chief varieties of candy are made up largely of 
glucose and starch, colored with anilin dyes. 

Molasses, Treacle, and Syrup.— Molasses and 
treacle are by-products formed in the manufacture of 
cane-sugar. Molasses forms a highly nutritious food. 
On account of the impurities it contains, molasses has a 
more pronounced aperient effect than refined syrup. 

Glucose, or grape-sugar, is chiefly made from starch 
by inver:>ion or hydrolysis. It is not nearly so sweet as 
cane-sugar and crystallizes with difficulty. It is present 
in small quantities, in combination with other varieties 
of sugar, in most fruits. 

I,actose, or sngar of milk, is the natural carbo- 
hydrate for the young, growing infant. It is less abun- 
dant in cows' milk than in human milk. 

Honey is sugar in a concentrated solution. It is 
made by bees from the nectar gathered from various 
flowers. It contains a crystallizable sugar resembling 
glucose, and a non -crystallizable form. 

Saccharin is u.sed largely as a substitute for sugar 
in cases of rheumatism and diabetes. 

I,evulose, or fruit-sugar, is also utilized as a form 
of sugar in certain cases of diabetes. 

Spices and condiments play an important role in 
increasing the appetite and aiding the digestive func- 
tions ; they have practically no nutritive value. By the 
action of these substances on the organ of taste as well 
as on the mucous membrane of the stomach, the appetite 
is stimulated and the secretion of gastric juice increased. 


In certain gastric disturbances as well as in diseases of 
the kidneys tiiey act as irritants and should be avoided. 

The peppers are among the favorite spices ; there 
are two varieties, the white and the black. 

Mastard. — Mustard is used chiefly in salads or with 
other foods, and has a marked tendency to increase the 
appetite. In large quantities and diluted with water mus- 
tard acts as an irritant to the stomach, producing' nausea 
and vomiting. 

Vinegar is produced from various alcoholic drinks 
and from fruits. It contains 5 per cent, of acetic acid. 

Horseradisli is a condiment that is much used with 

Satices, such as tomato, catsup, Worcestershire, and 
the like, increase the appetite and give a relish to certain 

Spices act merely by adding a flavor to foods, in this 
way increasing the appetite for foods that would other- 
wise be insipid. Those most in use are ginger, cinnamon, 
nutmeg, and cloves. 


One-fifth of the body-weight consists of fat. This is 
obtained in part from fatty food and in part from the car- 
bohydrates and the proteins. Most of the heat energy 
furnished the body is supplied by fat; it oxidizes very 
rapidly, and in this way spares the protein elements 
that would otherwise be required to furnish energy. 
Fats are digested in the intestine, where they arc emul- 
sified previous to being absorbed. The most u.seful forms 
of fat are cream and butter; other forms are bacon and 
cod-liver oil. When eaten too liberally, fats are liable to 


cause indigestion, and when this exists they should be 
taken only in very restricted quantities. 

Foods fried in fats are indigestible, and hot fats are 
more indigestible than cold. Fats and oils have a ten- 
dency to reheve constipation, but are contra-indicated in 

The most important animal fats are butter, cream, lard, 
suet, oleomargarin, cottolene, butterine, cod-liver oil, and 
bone-marrow. Of the vegetable fats, those most com- 
monly employed arc olive oil, cottonseed oil, linseed oil, 
cocoa-butter, and the oils obtained from nuts, such as 
cocoanut oil, peanut oil, and almond oil. Fatty foods 
are indicated' especially in wasting disorders and in con- 
valescence from certain acute diseases. 

There are many proprietaiy fatty foods on the market, 
some of which, are worthy of mention. In most of 
these the fats, usually eod-liirer oil, have been emulsified ; 
this emulsification aims to make the oil less objection- 
able to the taste and also to render it more easily diges- 

Butterine is a fat prepared from beef and hog fats, and 
is frequently used in this country instead of butter; 
oleomargarin is a similar preparation made from beef 
fat. Both butterine and oleomargarin arc wholesome 
fatty foods, the only objection raised against them being 
that they are often sold fraudulently for butter. 

Bone-marrow is a fat obtained from the large bones of 
the ox. It is used in the treatment of tuberculosis and 

1 the various forms of anemia. 





The various salts tJiat enter into the composition of 
the tissues of the body arc absolutely necessary for the 
maintenance of life. The most important, and by far 
that most universally found, is sodium chlorid, or com- 
mon table salt. It enters into the formation of all the 
tissues and secretions of the body with the exception of 
the enamel of the teeth. It forms about 60 per cent, of 
the sails of the blood. When taken in insuffieicnt quanti' 
ties or omitted entirely marked symptoms of mahiutrition 
soon appear. 

Potassium chlorid ranks next in importance to 
sodium chlorid. It is widely distributed in the body, 
but occurs in much .smaller amounts. 

Calcium salts are important chiefly on account of 
the extent to which they enter into the composition of 
the bones and the teeth. 

Phosphorus occurs in the muscles, bones, and blood. 
It is found as phosphate in both animal and vegetable 

The stilphur of the body is derived from egg albu- 
min, milk, and certain vegetables, in which it occurs as 

Iron is an important constituent of the hemoglobin 
of the blood, and is found also in musclc-fibcrs. 



Water is the chief constituent of all beverages, and 

also enters largely into the composition of solid food. 

The human body itself is composed of about 60 per 

cent, of water. While man can live for weeks without 


food, he can abstain from water for but a few days. 
Water is absolutely necessary as a solvent, and as it is 
constantly being^ eliminated by the skin, lungs, and kid- 
neys, this loss must be replaced by some means in order 
to maintain the functions of the body. This is most 
conveniently done through the agency of the various 
beverages. The best method, however, of replenishing 
the water-supply is tliat of drinking the water in its pure 
state, when it retains all its solvent properties. Some 
waters are taken for their laxative or purgative action, 
and others for the .salts which they contain. 

The amount of water consumed daily by the average 
person is from six to eight glasses. This varies, how- 
ever, with the amount and variety of food and exercise 
taken. The age, sex, and size of the individual and the 
season of the year also influence the total daily consump- 
tion of water. In very warm weather, for example, and 
under severe physical strain, much water that would not 
be lost in the cold season of the year is eliminated in the 
form of perspiration and be compensated for. 

Water is absorbed chiefly in the intestine ; a small 
amount is absorbed in the stomach, and but a very 
trifling amount, if any, in the mouth. The water ab- 
sorbed in the intestine is passed into the lymphatics and 
carried on into the circulation, whence it is eliminated. 

As previously stated, water is eliminated through the 
skin, kidneys, lungs, and feces. The amount of water 
excreted daily varies greatly under special conditions. 
In cold weather the skin is inactive and the kidneys 
excrete a markedly greater amount of water than in hot 
weather, when the sweat-glands functionate more actively. 
When there is a tendency toward liquid movements from 
the bowel, the elimination by the kidneys is lessened. 



In warm weather elimination by the lungs is stimu- 

According to the amount of mineral water they con- 
tain, waters arc classed as hard or soft. Rain-water is 
soft, znd is the purest form of natural water. The hard- 
ness of water is due to earthy carbonates; by boiling, 
the carbonic acid gas is driven off and the carbonates are 
precipitated, and the water thus rendered more suitable 
as a beverage. Boiling has the additional advantage that 
it destroys most of the micro-organisms that may be 
present in the water. 

Water often contains impurities, such as lime, mag- 
nesia, iron, and other salts, and micro-organisms, and it 
often becomes necessary to purify it for drinking pur- 
poses. Typhoid fever and cholera are communicated 
chiefly through the agency of polluted drinking* water. 
The best method of purification is by distillation, by 
which means both organic and inorganic impurities can 
be removed or rendered innocuous. This method is 
now used largely on shipboard. When distilled and 
aerated, sea- water makes a most pleasant beverage. 
Water may also be purified by means of filtration, char- 
coal and sand being used extensively for this purpose. 
Porcelain cylinders are also in common use. Whatever 
the filtering agent employed, unless it be kept clean it is 
liable to become a source of contamination rather than 
of purification. Owing to the fact that soluble impuri- 
ties often pass through the filter, filtered water is not 
nearly so reliable as distilled water. 

Mineral Waters. — Mineral waters are frequently 
taken as substitutes for ordinary water; at times they 
produce a most marked stimulating effect on various 




organs. Their efficiency is greatly enhanced when a 
"drinking cure" is combined with proper dietetic regu- 
lations. Mineral waters differ from ordinary waters in 
tlie greater amount of gaseous and solid matters they 
contain. The gaseous constituents of mineral waters 
are mainly carbon dioxid and sulphuretted hydrogen. 
The solid constituents are salts of sodium, potassium, 
magnesium, aluminium and calcium, iron, iodin, bromin, 
chlorin and sulphur. Taken before meals, waters con- 
taining carbonic acid have a soothing effect on an irri- 
tated stomach. Taken in excess, all carbonated waters 
I are apt to produce indigestion. 

! Some waters have a purgative effect, others a laxa- 

|_ tive, and still others a diuretic. Tbennal waters issue hot 

I from their springs, their virtue being said to be due to 

^ their heat. Some mineral waters have no medicinal vir- 

I tue whatever, and are utilized merely as drinking-water, 

I The following classification of mineral waters is taken 

from Cohen's Physiologic Therapeutics, Vol. IX.: 

k Simple acidulous coDtflins lai^e amouuta of car- 

bon dioxid ; example, Apullinaria. 
Alkaline acidulous contains lai^e amonnta of car- 
bon dioxid .ind also sodium curbonate; example, 
I. Albkline Snratc^ Vichy. 

lainend Alkaline mnriated acidulous contsins carbon di- 

walecs. oxiil, sodium carboaale, and sodium chlorid \ 

ple, Seltzer. 
Alkaline saline acidulous contains sul|>hate of 
sodiL in addition to bicarbonate and chlorid of soda, 
as Carlsbad water. 
Simple sodium chlorid contains sodium chlorid 
II Sod' 1 1 ^"'^ carbon dioxid. as Saratoga Congress. 

-J Sodium chlorid with iodin and bromin con loins 

ioilin and bromin in addition lo sodium cblorid, 
as Saratoga Kiasingen. 



in. Bitter waters contain a large proportion of sodium sulphate and 

magnesia sulphate, as Bedford Magnesia water. 
IV. Sulphurous waters eoalain hydrogen sulphid or some otlier sulphur 
conipouiid, as Kreuch l.ick Spring. 

CorbonBted iron-waters contain larger quantilies 
of carbonic acid, as Cresaon Spring water. 

Sulpbaled iron-waters contain fetrou.') .sulphate in 
V. Iran-waters. addition Lo sodium magnesia, and calcium sulphate, 
as Sharon ChaljbeaLe Spring. 

I ton-and- arsenic -water contains arsenic and iron, 
as Harbin Hoi Sulphur Spring. 
VI. Earthy mineral waters contain large amounts of calcium and mag- 
nesium salts, as Mount Qemens Mineral Springs. 
VII. Acratothermal waters do not contain any active mineral ingredients, 
bu( are oUained at a lemperalure of Ss" F. or over. 


Tea is a preparation made from the leaves of an ever- 
green plant known as thea. It is grown in Chiha^ 
Japan, India, Ceylon, and in North Carolina. There are 
two great classes of tea, the green and the black. 

The chief difference between the black and the green 
tea lies in the fact that black tea is fermented, while 
green is not. As in the process of fermentation the 
tannic acid becomes less soluble, black tea contains 
much less tannic acid than green tea. 

Tea has practically no nutrient ingredients. Its prin- 
cipal constituents are caffein and tannic acid, and its 
special aroma is due to a volatile oil. It owes its stim- 
ulating effect to the presence of caffein. As the action 
of tannic acid is detrimental to the process of digestion, 
tea should be so prepared as to contain as large a pro- 
portion of caffein as possible and the smallest possible 
amount of tannic acid. 

When the leaves are placed in boiling water, caffein is 
extracted very rapidly. Tannic acid, however, is much 


less soluble; it follows, therefore, that in order to have 
as little tannic acid in the tea as possible, the leaves should 
be boiled in water for as short a time as practicable. To 
prepare the infusion, pour boiling water on the tea-leaves 
and allow the mixture to stand where it will keep hot, 
though not boil, for from three to five minutes. The 
water used in preparing tea should not be hard or stale. 


CofTee was introduced into Europe in the same century 
as tea, and only a few years later. It is prepared from 
the seeds of CofTea arabica, which was originally grown 
in Arabia. The aroma of coffee is due to the presence 
of caffeol, an oil liberated in roasting. Coffee is often 
adulterated, chicory, acorns, and other substances being 
added for this purpose. The adulteration may not be 
injurious in its effect, but alters sometimes, even agree- 
ably, the flavor of the coffee. 

Preparation of Coffee.— In order to obtain coffee 
of the finest flavor, the beans should be roasted and 
ground shortly before they are to be used, as the flavor 
is impaired by exposure to the air after grinding. The 
water should have reached the boiling-point before it is 
poured over the coffee. The pot should then be placed 
for a few moments in a hot place, but boiling must not 
be allowed to continue, or the aroma will be lost and the 
coffee contain too large a percentage of tannic acid. 

The effect of coffee on the system is that of a stim- 
ulant, due to the caffein present; it acts directly on the 
brain centers, stimulates the heart, and deepens the res- 
pirations. It is an excitant of the nervous system, and in 
some persons produces nervousness, excitability, and 
in others it acts as an agreeable stimulant. 





Cocoa was introduced into Europe long before either 
coffee or tea. It is prepared from tlie seeds of the cacao 
tree. The seeds are contained in a pulpy fruit, some* 
what resembling a cucumber, from which they are 
extracted. Cocoa, as ordinarily prepared, is made by 
grinding the seeds into a paste, to which sugar or starch 
is added ; if starch is used, the cocoa is boiled for a few 
minutes, but if sugar is added, the cocoa only requires 
the addition of boiling water or milk. 

Cocoa, while a stimulant, is less apt to induce nervous 
symptoms, such as sleeplessness and palpitation, than 
either tea or coffee. By reason of the large proportion 
of sugar and fat contained in it, however, when used in 
excess, cocoa is likely to produce indigestion. When 
not too rich, it forms a nutritious drink especially useful 
for children and for convalescents. 

Chocolate is prepared by adding starch, sugar, and 
such flavoring substance as vanilla to cocoa. In addi- 
tion to their stimulant effect, cocoa and chocolate pos- 
sess a marked nutrient value not possessed by either tea 
or coffee. 


Alcohol is produced by the fermentation of sugars 
with yeast. The principal constituent in all alcoholic 
beverages is ethyl alcohol. The glucose contained in 
fruits is fermented directly into alcohol ; whereas the 
starches in such substances as potatoes, grains, etc., are 
converted into de.\trin and maltose, and then, by the aid 
of diastatic ferments, before the alcoholic fermentation 
can take place, they are converted into glucose. 

The food valne of alcohol has been a subject for 
discussion for many years. Although all admit that 



alcohol taken in excess is a poison and is detrimental 
to health, yet opinions differ widely as to the food value 
of alcohol taken in moderate quantities. There are those 
who maintain that alcohol, even in small quantities, is 
detrimental to health and acts as a poison ; whereas 
others believe that, on the contrary, when taken in small 
quantities it possesses a considerable nutrient value and 
is to be recommended as a valuable food. The most 
recent as well as the most exhaustive work bearing on 
this subject has been done by Atwater, in his experiments 
on " The Nutritive Value of Alcohol," in The Physio- 
logic Aspects of the Liquor Question, 1903. According 
to the writer the effect of alcohol in small quantities is 
slightly to increase the digestibility of protein, but not to 
alter the digestibility of other nutrients — that is, carbo- 
hydrates and fats ; that at least 98 per cent, of the alco- 
hol ingested is oxidized in the body, whereas ordinarily 
98 per cent, of the carbohydrates, 95 per cent, of the 
fats, and 93 per cent, of the protein are oxidized; the 
alcohol is therefore oxidized more completely than are 
the nutrients of ordinary foods. 

The conclusion reached by Atwater, based on direct 
experiments, is that the fat protection following the use 
of alcohol is very .slightly different from that following 
the taking of ordinary food, and that alcohol protects 
the body-fat quite as effectively as do the fats and carbo- 
hydrates of the food for which it is substituted. The 
power of alcohol to protect the protein of food or body- 
tissue, or both, from consumption is clearly demonstrated. 

Alcohol, carbohydrates, and fats replace one another 
as sources of energy, so that as one is oxidized the other 
is correspondingly spared. 

Atwater found that in most of the experiments " alco- 


hol was certainly a source of heat for the body " and 
contributed its share of energy for muscular work. 

Atwatcr gives the following proportions as to the 
availability and fuel value of alcohol in nutrition as com- 
pared with carbohydrates and fats: i gm. of alcohol, ij 
gm, of carbohydrate, and | gm. of fat yield the same 
amount of energy to the body. Inasmuch as alcohol 
contains no nitrogenous constituents, it can not be looked 
upon as a food tending to repair tissue, but merely as a 
fuel that, on oxidizing, forms animal heat. 

Alcohol is easily digested and readily absorbed in the 
alimentary tract; as a food, however, it is costly, and 
the danger of addiction and excess in its use is great. 
The habitual use of alcohol even in con.siderable quanti- 
ties does not tend to produce injurious efiects in many 
persons ; whereas in others changes, especially of a 
cirrhotic nature, in the tissues, blood-vessels, liver, kid- 
neys, etc., are Hable to occur. In certain diseases, 
especially those accompanied by malnutrition, extreme 
feebleness, and exhaustion, alcohol acts as a food and 
serves an excellent purpose in restoring strength to a 
weak and enfeebled body. 

Alcoholic beverages are divided into several classes, 
e. g., spirits, liqueurs, and bitters, malt liquors, wines, etc- 


Spirits are produced by fermenting saccharine sub- 
stances and obtaining the alcohol by distillation. Of 
the substances, corn, rice, barley, molasses, and potatoes 
are those most commonly utilized for this purpose. In 
addition to the alcohol, by-products are formed, and it 
is to these that spirits owe their characteristic flavor and 
odor. The by-products contain the higher alcohols, such 




as propyl, butyl, and amyl alcohol, a mixture of these 
forming what is known as fusel oil. 

Whisky. — The United States Pharmacopeia defines 
whisky as " an alcoholic liquid obtained by distillation 
of the mash of fermented grain (usually of mixtures of 
corn, wheat, and rye), and at least two years old." 
Whisky possesses an alcoholic strength of from 50 to 
58 per cent, by volume. It should be free from dis- 
■ agreeable odor. The ether and aldehyds contained in 
whisky become altered in character as it ages, and the 
flavor is thus rendered more agreeable. 

Brandy, — In the United States Pharmacopeia brandy 
is defined as an "alcoholic liquid obtained by distilla- 
tion of the fermented unmodified juice of fresh grapes, 
and at least four years old." Brandy contains from 46 
to 55 per cent, by volume of alcohol. The quality of 
brandy depends upon the variety of grapes used and 
upon the length of time the brandy is allowed to stand: 
the older the brandy the better the quality. With 
brandy, just as with whisky, on standing ethers and 
aldehyds are produced, to which the special flavor of the 
brandy is due. The color of brandy is due to the tannic 
acid extracted from the oak casks in which the brandy 
is contained. There are many inferior grades of brandy 
on the market, some being merely alcohol colored and 
flavored with various essences. 

Rutn. — Rum is the product of the distillation of fer- 
mented molasses, its flavor being due to certain by- 

Gin. — Gin is produced by the distillation of rye and 
malt mash, its flavor being due to juniper berries which 
are added during fermentation. 
. Ifiqneurs or cordials and bitters contain a large 



proportion of alcohol and a high percentage of sugar and 
essential oils. 

Malt Iriqnors. — Under the heading of malt liquors 
arc included beer or ale and stout or porter. These 
beverages are made by fermenting malt and hops. The 
mild or bitter beers are distinguished by the relative pro- 
portion of hops contained in them; the n;ilder forms 
contain considerable quantities of hops, whereas the bit- 
ter ones contain but small amounts. 

Porter and Stout. — Porter and stout are made by 
fermenting malt, the latter, however, being roasted, dur- 
ing which process a certain amount of caramel is pro- 
duced. It is to this substance that the dark color is 
due. Beer as well as stout contains from 3 to S percent. 
of alcohol, from 2 to 5 per cent, of dextrin, and from 
0.5 to 1 per cent, of sugar. 


Wine is produced by the fermentation of grape-juice, 
the juice being first pressed from the grape by crushing. 
There are a number of factors, such as the character of 
the grape utilized, its cultivation, and the method of 
manufacturing, that enter into the production of a good 

Of the important ingredients of wine may be men- 
tioned water, acids, alcohol, sugar, ethers, glycerin, and 

Acids. — The most important acids contained in wine 
are tartaric, malic, and tannic ; others of less impor- 
tance are acetic and succinic. The total amount of acids 
in wine varies, but rarely exxeeds 0.5 per cent. 

Alcohol, — There are several alcohols present in wine ; 
ethyl alcohol occurs in largest quantity; amyl, propyl, 



and butyl alcohol are also present in varying amounts ; 
natural wine never contains more than 16 per cent, of 
alcohol ; if it contains more than this amount it has 
been " fortified." This is often done, especially when 
the wine is to be shipped from warm countries to foreign 
districts, to prevent it souring. 

Sugar. — Sour wines contain about i [jer cent, and 
sweet wines about 4 per cent, of sugar; it is evident, 
therefore, that sugar is present in too small a quantity 
to be of any food value. 

Ethers. — Many varieties of ethers are present in wine ; 
they are produced by the action of the alcohols and acids 
upon each other. It is to the character and quantity of 
the ethers contained in them that the flavor of various 
kinds of wines is largely due. 

Glycerin. — Glycerin is present in wine in about one- 
fourteenth of the volume of the alcohol. 

Extractives. — A large part of the solid material of the 
wine is made up of extractives. 

Varietiesof Wines.— From a dietetic standpoint the 
classification of Chambers is probably the most practi- 
cal ; according to this author, wines are divided into 
seven classes: i. Strong dry wines. 2. Strong sweet 
wines, 3. Aromatic wines. 4. Acid wines. 5. Spark- 
ling wines. 6. Perfect wines. 7. Rough or astringent 

I. Strong Dry Wines. — These are wines that contain 
a large percentage of alcohol, to which, as a rule, addi- 
tional alcohol has been added in their production ; in 
other words, they are "fortified." Examples of this 
class of wines are port, sherry, and Madeira. Port con- 
tains from 15 to 20 per cent, of alcohol and considerable 




tannic acid. Sherry is a fortified wiiie ; it contains from 
15 to 23 per cent, of alcohol. 

2. Strong Sweet Wines. — These wines contain fruit- 
sugar in quantities sufficient to act as a preservative and 
prevent furtiier fermentation. Under this head may be 
mentioned Tokay, Malaga, and sweet champagne. They 
contain from 1 8 to 22 per cent, of alcohol and from 3 to 
5 per cent, of sugar. Owing to their sweetness they are 
taken in small quantities. 

3. Aiomatic Wines. — Aromatic wines possess a superior 
flavor and contain essential oils and considerable alcohol ; 
examples of this class of wines are Moselle, Capri, and 
some of the Rhine wines. 

4. Acid Wines. — The distinguishing feature of this class 
of wines is the large quantity of acid they contain. 

5. Sparkling Wines. — Sparkling wines contain consid- 
erable quantities of carbonic acid gas, to which their 
exhilarating effect is due. The chief variety of this class 
of wines is champagne. The diyness or sweetness of 
champagne depends upon the proportion of cane-sugar 
and cognac added during the process of manufacture. In 
the manufacture of dry champagne 8 per cent, of sugar 
is added, while the sweet brands contain as much as 16 
per cent. 

6. Perfect Wines. — Perfect wines are defined by Cham- 
bers as those containing alcohol, water, sugar, ethereal 
flavors, fruity extractives, and adds. Under this head 
come Burgundy and Bordeaux, 

7. Bongli Wines. — Rough wines contain considerable 
quantities of tannic add, to which they owe their astrin- 
gent efl^ect. They contain little alcohol and are of slight 
value for medicinal purposes. 




Malt liquors, when taken in 'moderate quantities, seem 
to aid digestion, increase the appetite, and stimulate gas- 
tric secretion. Occasionally, especially in those who 
lead a sedentary life, they give rise to indigestion and 
gastric acidity. On account of the large quantities of 
carbohydrates they contain, they have considerable food 
value. The use of malt liquors is contra-indicated espe- 
cially in such conditions as gout, obesity, diabetes, and 
diseases of the urinary tract. 

Wines appear to exert a depressing effect on the gas- 
tric secretion. Taken in moderate quantities, however, 
by increasing the appetite and the motor function of the 
stomach, this depressing effect is not only overcome, but 
the digestion is also greatly improved. 

Cider is a beverage prepared from the fermented juice 
of ripe apples. The amount of alcohol contained in this 
beverage varies between 3 and 8 per cent, by volume. 
It also contains malic acid, salts, sugar, albuminoids, and 




Concentrated foods arc those from which the larger 
portion of the water present has been abstracted, and 
thus the weight and the bulk of the food diminished. 
There arc many patented concentrated foods on the 
market. They find their chief use in the treatment of 
patients who take too little of the usual forms of food to 
maintain strength, and, second, in cases where it is impor- 
tant that a large quantity of nourishment be taken. 

Food can be concentrated to various degrees. Desic- 
cated meat is the most concentrated form of protein ; 
sugar the most concentrated form of carbohydrate ; and 
olive oil the most concentrated form of fat. 

1. Concentrated Proteins. — These foods are pre- 
pared from milk, meat, eggs, and vegetables. Meat is 
concentrated by drying, and in this form it is generally 
indigestible, which can, however, be overcome by prc- 
digestion or powdering. 

2. Concentrated Vegetables. — Many vegetables, 
such as potatoes, carrots, cabbage, and the like, arc con- 
centrated by drying. Tiiey are utilized only in those in- 
stances in which it is impossible to secure fresh vegetables. 

Bread is frequently dried and eaten in the form of 
" hardtack," when it is impossible, as during sea-voyages, 
to obtain fresh bread. 



By preservation of food is meant tlic process by which 
the food is so changed that it can be kept for a longer or 
shorter period of time without undergoing putrefaction. 
The process of fermentation is induced by micro-organ- 
isms present in the atmosphere coming into contact with 
the food and contaminating it. Since putrefactive germ.s 
require a certain amount of moisture and heat for their 
growth, such foods a.s contain little water and that are not 
kept too warm are rot so likely to undergo decomposi- 
tion ; on the other hand, foods containing much water 
undergo fermentation very rapidly. To prevent this proc- 
ess, four methods of preservation are, according to Yco, 
available : 

1. Drying. 

2. Exclusion of air. 

3. Exposure to cold, 

4. Treatment with antiseptic chemic agents. 

1. Drying. — By this process a large proportion of 
the water is abstracted. Vegetables, such as carrots, 
peas, potatoes, etc., are preserved by drying. Milk, in the 
form of nutrose, eggs, as egg-powder, and fruits are often 
preserved in this manner. 

2. Exclusion of Air. — Air may be prevented from 
coming into contact with food in a number of ways: by 
immersing the food in oil or fat ; by heating the food, so 
as to evaporate the external layers; by coating with 
some impermeable substance, as oil, salt, sawdust, var- 
nish, or paraffin. Fish are frequently preserved by im- 
mersion in oil or by smoking. Ham and bacon are pre- 
served by smoking, by which process the outer surface 
becomes coagulated and impermeable. Eggs are pre- 



served by covering the fresh eggs with some imperme- 
able substance, such as oil, fat, beeswax, or sawdust. In 
order properly to preserve food by exclusion of air, it is 
higlily important that the food be perfectly fresh, and that 
any air that may be present be cxix^licd. 

In canning, the food to be preserved is heated in tin 
cans until steamed, when, all the air having been expelled, 
the can is soldered and rendered air-tight. 

3. Exposure to Cold. — Food can be preser\'ed in- 
definitely by ice. Meat and fish, which are often pre- 
served by this means, should be cooked at once after 
thawing. Frozen meat loses about 10 per cent, more of 
its nutritive value in cooking than fresh meat. Frequently 
food is not kept directly on ice, but in refrigerating cham- 

4. Treatment with Antiseptic Chemic Agents. — 
I. Salting. — The salting of food is a method that has 
been practised for many centuries. In this way meat 
and fish are easily preserved. The pale color of the 
meat produced by salting is overcome by adding a little 
saltpeter in addition to common salt. After the salting 
has been accomplished, it is often followed by smoking. 

2. Snear in strong solution acts as an antiseptic, and 
fruits arc thus often preserved in concentrated syrups, 

3. Vinegar acts as an antiseptic in preserving cucum- 
bers, pickles, oysters, etc. 

4. Other Antiseptics for Preserving Foods. — Among 
these substances are sulphur vapor ; weak carbolic acid ; 
strong acetic acid; injections of alum and aluminium 
chlorid into the blood-vessels; boric acid; borax; sali- 
cylic acid ; formaldehyd. 

The use of antiseptics to preserve foods is usually 
condemned, and laws have been enacted to prevent the 



adulteration of such foods as milk, beer, etc., with anti- 
septics, as salicylic acid, formaldehyd, etc. While small 
quantities of these substances, even taken for a consider- 
able length of time, may not prove injurious, in large 
quantities they are dangerous. 


To this class of foods belong those preparations that 
are so concentrated as to furnish a large amount of food 
in small bulk ; being of small bulk, they can be added 
to liquid foods, and thus the nutritive value of the latter 
increased without increasing the total quantity of liquid 
taken. A number of these preparations have been men- 
tioned under the head of beef-juices and meat-powders. 
The various casein preparations, among which may be 
mentioned nutrose, eucasein, sanose, and plasmon, are 
artificial foods. 

Among other artificial food preparations may be men- 
tioned : I. Pemmican. 2. Peptone products. 3. Mosquera 
" Beef Meal." 4. Somatose. $. Legumin. 6. Alcuronat, 

1. Pemmican is prepared by cutting meat into thin 
slices and allowing them to dry; sugar and dried fruits 
are added, the nutritive value of the meat being thereby 

2. Peptone products are predigested protein foods. 
When given in large quantities they tend to produce 
diarrhea, and are objectionable to many patients on account 
of their disagreeable taste. Among the principal peptone 
products manufactured may be mentioned Kemmerich's, 
Koch's, Benger's, Savory & Moore's, Carnrick's, Ar- 
mour's Wine of Beef Peptone, and Panopcptone. 

3. Mosquera Beef Meal is prepared by partially 
digesting meat by means of a ferment obtained from 




pineapple juice. According to Chittendtn, this product 
contains go per cent, of nutritive matter (13 per cent, of 
fat and "jj per cent, of protein), 

4. Somatose is a predigested meat consisting of albu- 
ntoses. It is a yellowish powder, tasteless, odorless, and 
highly nutritious, and is usually well borne even in gas- 
tric disturbances. 

5. I^egnmin consists of the casein of the legumes, and 
is a highly nutritious protein food. 

6. Aleuronat is a brownish powder, chiefly utilized as 
a food for diabetics. It contains 80 per cent, of protein. 

7. Tropon is prepared mainly from fish and vegeta- 
bles, and as sold on the market appears as a brownish, 
tasteless powder. It is eaten mixed with broths or 

Artificial Proprietary Foods. — A large number of 
proprietary foods designed as substitutes for milk for 
infants and invalids are on the market. Infants fed upon 
such foods alone are apt to become rachitic. Some of 
these foods have little food value; especially the amyla- 
ceous foods in which the starch has not been predigested. 
Many of these preparations contain too little fat and far 
too great a proportion of carbohydrates. According to 
Holt, "when children are fed upon foods lacking in fat 
the teeth come late, the bones are soft, the muscles 
flabby," while "children fed upon foods containing too 
much sugar are frequently very fat, but their flesh is very 
soft; they walk late and they perspire readily about the 
head and neck," 

Hutchinson divides proprietary foods into three classes : 
I. Foods Prepared from Cows' Milk with Various Ad- 
ditioiis or Alterations, and Requiring only the Addition of 
Water to Pit Them for Immediate Use. — To this class 



belong Malted Milk, Nestle 's Food, Lactated Food, Cam- 
rick's Food, Cereal Milk, Wyeth's Prepared Food, and 
Wampole's Milk Food. Tliese foods arc prepared from 
flour baked and mixed with milk or cream and then dried. 
By means of the nialt which is added the starches are 
converted into dextrin and maltose. 

2. Farinaceous Foods Prepared from Cereals of which 
the Starch has been Partly or Wholly Converted into Dex- 
trin or Sugar, and which Require the Addition of Milk to 
Fit Them for Use, — To this cla.'^s belong Mellin's Food. 
Savory & Moore's Infant Food, and Henger's Food. 
These foods are prepared by mixing equal parts of wheat 
flour and barley malt with bran and potassium bicarbon- 
ate. The mixture is made into a paste withw'ater, and 
kept at a warm temperature until the starch is converted 
into dextrin and maltose. As these foods are poor in 
fat, protein, and mineral matters, they are added to milk 
in order to render them more nutritious. 

3. Farinaceous Foods in which the Starch has not been 
Fredigested. — To this class belong Ridge's Food, Neave's 
Food, Imperial Granum, and Robinson's Patent Barley. 
These foods are poor in fat, protein, and mineral mat- 

Other Proprietary Foods. — Crackers are prepared from 
flour, water or milk, and are baked into various forms. 
Baking-powder and soda, and frequently milk, butter, 
sugar, and flavoring extracts are added. Crackers are. 
as a rule, easily digested. 

Halt Extracts. — Malt extracts are manufactured by 
heating a solution of malted barley at a moderate tem- 
perature in vacuo. Malt extracts are especially useful as 
beverages for those weakened by chronic disease, as 
tuberculosis or anemia, and in the convalescence from 


acute diseases, as after typhoid fever or pneumonia.. 
Among the various malt preparations may be mentionec! 
Maltinc, Kepler's Extract of Malt, and Hofi's Malt 


The cooking of food is an art practised by all races, 
savage as well as civilized. Food is cooked to improve 
its flavor, to soften it so that it can be masticated and 
more easily digested, and finally to destroy all parasites 
and disease germs that may be present in the raw food. 
By cooking certain flavors are developed, which by their 
savoriness increase the appetite and the taste for the 
food. Cooking, moreover, destroys the tough fibrous 
envelopes that surround many foods, thus permitting 
the food to be more easily acted upon by the various 
digestive fluids. Various parasitic organisms present 
in many foods are destroyed by cooking, and the food 
thus freed from one of its most dangerous elements. 
On cooking, the protein in food coagulates ; under the 
influence of dry heat the starches are gradually converted 
into dextrin ; whereas, under the influence of moist heat 
the granules gradually swell until they rupture their en- 
velopes. Sugars, by boiling, are changed gradually into 
caramel, which is the source of the odor frequently given 
off in the cooking of food. When fats are heated they 
undergo a change, with the production of free fatty acids 
which are often responsible for the odors that exist in the 

Cooking of Meat. — Boiling. — In boiling meats tlie 
temperature of the water should not exceed the tempera- 
ture necessary for tiie coagulation of the protein.s. In 
order that the meat may retain as much of its flavor as 
possible, it should lie immersed in boiling water for a few 

Various factors in their bearing on diet. 87 

moments ; in this way the protein on the surface imme- 
diately coaguiates, thus preventing the escape of the con- 
stituents and so retaining all the nutritive elements in the 
meat. After this has been accomphshed, the temperature 
of the water may be lowered and the process of cooking 
continued. The broth which is so produced is thin and 
poor, if a rich, nutritious broth is desired, the meat 
should be cut into small pieces and placed in cold water, 
and the temperature gradually increased to 150° F. In 
this way the nutritious elements of the meat pass out 
into the broth. 

Boastiiig. — In roasting, the meat is first exposed to a 
high temperature and afterward cooked slowly; thus, the 
outer layers coagulate at once, preventing escape of the 
juices. Roasting not only prevents evaporation of the 
flavors of meats, but by its effect on the extractives de- 
velops savory odors and flavors. 

Baking. — Baking much resembles roasting, except that 
by the latter process the heat is applied all around the 
meat instead of only to one side. 

Stewing.— -For this purpose meat is cut into small 

t pieces and placed in a small quantity of water. The 
water is heated slowly, but not allowed to boil ; a certain 
amount of the nutritious substances thus passes into the 
water, which then becomes rich, and to which flavoring 
substances and vegetables are added. Inasmuch as the 
juice is eaten with the meat, none of the nutritious in- 
gredients is lost. 
Braising. — In this process the meat is placed in a small 
vessel and covered with a strong liquor of vegetable and 
animal juices; it is then heated, but not boiled. The 
tough fibers of the meat are thus loosened and made 
tender ; the meat also becomes impregnated with vegeta- 



bles and spices present in the juices, wJiich enhance its 

Broiling. — Broiling and roasting are similar processes, 
except that in the former smaller portions are utilized; 
the process is thus more rapid, a large surface being ex- 
posed to the direct action of the heat. 

Prying. — In this process the meat is put into boiling 
fat, with which it becomes saturated ; fatty adds are thus 
produced, which have a tendency to irritate the stomach 
and cause indigestion. 

Cooking of Fish.— Fish may be boiled, broiled, 
baked, and fried. Boiled fish is most easily digested. 
Inasmuch as the flavoring substances are more easily 
dissolved out into the water and lost, less time should be 
consumed in boiling fish than in boiling meat. Sir Henry 
Thompson has shown that even with careful boiling 5 per 
cent, of the solid matter of fish is apt to be ; for this 
reason steaming is often preferable. 

Effect of Cooking.— The effect of cooking on meat 
is to diminish its watery constituents, tlius concentrating 
and rendering it more nutritious ; by this pi ocess also the 
extractives as well as some of the fats are partly removed. 

Effect of Cooking on Vegetables. — The important object 
in the cooking of vegetables is to rupture the cellulose 
envelope and so to soften the contained starch granules. 
Under the influence of heat and moisture the starch 
swells and bursts its envelope, forming a paste ; this 
paste, in its turn, expands and ruptures the cellulose 
envelope ; cooking, therefore, renders vegetable foods 
more easily digestible. 

As has been pointed out, in the cooking of meats a 
certain proportion of the ingredients is lost. Unlike 
meats, however, vegetables become more wateiy in cook- 


ing. In this condition they are more easily acted upon 
by the gastric secretion ; on the other hand, the addition 
of water in cooking so increases theirbulk that the motor 
function of the stomach is apt to be overtaxed. 

When food is cooked rapidly there is a tendency to 
overcook the outer layers and to leave the inner under- 
done. The better plan, therefore, is to cook food slowly 
for a longer period of time at a lower temperature. 
Various appliances are on the market which have for 
their object the production of a continuous action of a 
moderate heat at the expense of as little fuel as possible. 
The " Aladdin Oven " of Dr. Edward Atkinson is an 
apparatus of this kind. 


Disease may be caused by taking too little or too 
much food, and also by a diet that is not well balanced — 
that is, does not contain the combination of food elements 
in the correct proportions — and by other dietetic influ- 
ences, the precise nature of which is as yet obscure. It 
may also be caused by certain poisons or disease germs 
or parasites taken into the body with food and drink. 

The diseases due to insufficient food are starvation, 
malnutrition, marasmus, and some forms of anemia. 
Chlorosis is liable to occur in underfed girls. 

Overeating probably causes as much disease as over- 
drinking. Among the most striking of are gout 
and obesity. Diseases of the skin, kidneys, liver, and 
other organs may also be due to this cause. 

Lack of fresh food may produce scurvy and an im- 
properly balanced diet may cause rickets. 

The abuse of various beverages deserves mention. 




The effects of the abuse of alcohol and the nervousness 
resulting from the excessive use of tea and coffee are 
well known. 

Acnte food-poisoning is usually due to the action 
of ptomains, and this is called p to main -poisoning. Pto- 
mains or toxins are poisonous substances caused by 
the action of bacteria, and may be generated in nitrog- 
enous foods or in the alimentary tract. They resemble 
alkaloids, and when absorbed are partially destroyed by 
the liver. The symptoms vary, but nausea, vomiting, 
purging, pain in the abdomen, and collapse are the most 
frequent. Various names are applied according to the 
food which the trouble, as mi Ik -poisoning (galac- 
totoxismus); (tyrotoxismus) ; mussel- 
poisoning (mytilotoxismusj ; fish -poisoning (ichthyotoxis- 
mus) ; meat-poisoning (kreotoxismus). Faultily cured 
sausage sometimes causes poisoning (botulismus), and 
epidemics of pneumonia have resulted from eating in- 
fected bacon, infected ham, or other spoiled meat. The 
poison may be present without producing any change in 
the appearance of the meat. 

Other forms of food-poisoning are as follows : 

Mushroom-poisonmg. — Poisonous fungi are frequently 
mistaken for edible mushrooms and lead to poisonous 
.symptoms. The active principle in these fungi is called 
mu.scarin. If there is a ring about the stalk, the mush- 
room peels easily and has pink gills, it is said to be non- 
poisonous. This is not a safe rule, as some of the most 
poisonous varieties answer to this description. 

Grain-poisoning. — There are three forms of grain-poi- 
soning — ergotism, pellagra, and lathyri^m. Most cases 
and epidemics have occurred among the poverty-stricken 
European peasants. 


EigotiBm (sitotoxismus) is due to eating spurred rye, 
from which the drug ergot is obtained. I^thyrism 
(lupinosis) is caused by eating the chick-pea. Pellagra 
(maidismus) 13 caused by eating fermented maise. It is 
frequently seen in Italy. 

Beriberi is a disease attributed to the use of an excess 
of carbohydrate food or to spoiled rice. It is thought that 
it may be of bacterial origin. 

Actinomycosis or lumpy-jaw, a disease of cattle, i.s some- 
times transmitted to man. In some of the cases the 
patients were in the habit of chewing raw grain. 

Foot-and-mouth disease is another disease of cattle 
which may be transmitted by the use of milk from cows 
suffering with it. Such milk .should not be used. If the 
disease is suspected the milk should be boiled. 

Hydatid Disease. — Cysts of a peculiar character some- 
times occur in man by taking the eggs of a dog tape- 
worm (T^nia echinococcus) into the body with the food. 
Green salads are the most frequent source of infection. 
The disease is almost unknown in America. 

Idiosyncrasies. — Curious food idiosyncrasies exist 
and must be borne in mind. They are more often fancied 
than real. Urticaria (hives) may be caused in some people 
by eating crabs, oysters, strawberries, and other articles 
of food. Gastric pain, vomiting, diarrhea, and other 
symptoms may be produced by such foods in some per- 
sons, while others eat them with impunity. 

Parasites. — Certain parasites may be taken in with 
food or drink. Many of these are rare, and seldom if 
ever seen in America. Among them may be mentioned 
the following : AmcBba coli, taken in with drinking-water, 
is the cause of one form of dysentery. 

Several species of tapewonn (Tienia solium in pork, 



T. mediocanellata in beef, etc.), of which the beef tape- 
worm is the common variety in the United States, may 
be met with. 

The pin-worm (Oxyuris vermicularis) and the ronnd- 
worm (Ascaris iumbricoides). the eggs of which are sup- 
posed to be taken in water or raw food. Tlie hook-worm 
(Strongylus duodenale), which causes a severe anemia, is 
taken in drinking-water. The trichina is taken in with 
raw pork, and the fllaria is taken in with drinking-water. 

Infected Milk. — Certain diseases may sometimes be 
transmitted by infected milk. Among these ^re diarrheal 
diseases, diphtheria, scarlet fever, typhoid fever, and 
Asiatic cholera. The last two are usually carried by 
infected water. 


Food adulteration is of two kinds : that which is in- 
jurious and that which is non-injurious. The latter is 
practised where there are no fixed standards, or, where 
such do exist, in debasements from these fixed standards. 
Adulterations may be classified as follows : 

1. Conventional— to suit the taste and demands of 
the public. Such adulterations are usually effected by 
means of coloring-matters, many of which are harmful, 
and by bleaching certain products. 

2. Accidental or incidental — arising from environ- 
ment, carelessness, or incompetency on the part of the 
producer, manufacturer, or Ins agents. This usually 
consists in an admixture of some foreign substance, such 
as husks, stems, leaves, etc. 

3- Arbitrary — to comply with or take advantage of 
certain fixed arbitrary standards. 

4. Intentional — for purposes of gain and competition. 

^^ 3 Art 

^^^^^L certain 
^^H 4. Inti 




A Table of the Various Adulterations} 






Sulphate of alum. 



Canned vegeta- 

Salts of copper, lead. 

bles and meat. 


Salts of mercury in 

the rind. 

Candy and con- 

Poisonous colors, ar- 


tificial essences. 


Cocoa and 

Oxid of iron and 


other coloring- 


Cayenne pepper. 

Red lead. 





Alum salt, spirit of 





Caustic lime, alum. 


Chromate of lead. 

sulphate of lime. 




Infested with para- 




Anilin colors, arti- 

ficial essences. 



Salts of copper, alum. 


Anilin colors. 




Cayenne pepper, ar- 

tificial essences. 


Salts of tin and lead. 



Other starches which are 
substituted in whole or 
in part for the genuine 

Water, burnt sugar. 

Flours other than wheat, 
inferior flour, potatoes. 

Water, other fats, excess 

of salts, starch. 
Excess of water. 


Chicory, peas, rye,beans, 
acorns, chebus-nuts, 
almond or other nut- 
shells, burnt sugar, low- 
grade coffees. 

Animal fats, starch, flour, 
and sugar. 

Ground rice-flour, salt, 
ship-bread , Indian 

Ground rice. 

Turmeric, Cayenne pep- 
per, mustard, inferior 
varieties of ginger. 

Water, sugar. 

Glucose, cane-sugar. 


Starch, stearin, salt. 
Yellow lakes, flour, tur- 
meric jCayenne pepper. 
Burnt sugar, annatto. 


Gelatin, apple-jelly. 

Apples, pumpkins, mo- 

Flour, ship-bread, linseed 





Ashes from oven, 
grit from mill- 


Meat damaged in 
the process of 


Oxid of iron. 

Grit and sand. 

Pollen of various 
plants and in- 

Sand, dirt. 

Old and wormy. 


Burnt sugar. 

Sand and dirt, in- 
sects dead and 

* From Bulletin No. 2^, Division of Chemistfy, United States Depart- 
ment of Agriculture. 











Flour, starches. 



Spent bark. 



Foreign leaves, spent tea, 
plumbago, gum, indigo, 
Prussian blue, China 
clay, soapstone, gyp- 

Ferruginous earth. 


Sulphuric, hydro- 
chloric and pyro- 

Ueneous acids. 
Anilin colors, crude 



Sulphate of potas- 



Wood alcohol is sometimes used to adulterate alco- 
holic beverages, flavoring extracts or drugs. It may 
cause blindness or death. 

Lead and copper or white salts may occasionally find 
their way into canned food. This may be used intention- 
ally. Lead may come from solder dropped in the can or 
from using dull tin (teme or roofing-tin) for the cans. 
Only the bright tin should be permitted. 

Preservatives. — Various chemicals are mixed with 
foods to preserve them. In some countries the use of 
preservatives is forbidden. Borax, boric acid, salicylic 
acid, sulphate or bisulphate of sodium are the most fre- 
quent. They are all injurious, and if taken into the body 
continuously produce disturbances of digestion, lower 
the nutrition, and may cause disease of the kidneys. 
Formaldehyd is frequently used, and in general it may 
be stated that its use is undesirable and dangerous. 


There arc four methods of feeding infants : (a) Breast- 
or maternal feeding, (d) Wet-nursing, (c) Mixed feed- 
ing — /, c, breast-feeding supplemented by bottle-feeding. 
((/) Bottle- or artificial feeding. 

(a) Breast-feeding. — This is the natural and best way 
to feed a baby, and every mother, if she is capable, should 
be instructed about nursing her infant The mental 
attitude of the mother has much to do with the secretion 
of milk, and the nurse should never discuss the mother's 
probable incompetency with her. All conversation should 
be hopeful and encouraging. If the baby is not gaining 
properly, tel! the physician and not the mother. 

During the later months of pregnancy the breasts 
should be examined, and if the nipples arc short they 
should be gradually lengthened by gentle traction several 
times a day. If they are inverted, a breast-pump may 
be needed to draw them out at first. During the entire 
nursing-period the breasts should be washed after each 
nursing, preferably with a boric acid solution. This does 
much toward preventing ulcers, fissures, and inflamma- 

During the first forty-eight hours the child receives 
practically no nourishment from the breast, the only 
fluid secreted during this time being a yellowish creamy 
sub.stance known as colostrum. This has a laxative 
effect upon the child's bowels. The child should, 


however, be put to the breast at regular intervals to 
stimulate the secretion of milk, which becomes free on 
the beginning of the third day, although it may be de- 
layed a day or two longer. During the first two days 
the nursing child docs not require anything except what 
it gets from the breast. It may, however, be given a 
teaspoonful or two of warm boiled water or of a 5 per 
cent, solution of milk-sugar. If the free flow of milk is 
delayed beyond forty-eight hours the child must be given 
nourishment, but should nevertheless be put to the breast 
at regular intervals, to help establish the milk secretion. 
Neglect of this important point often causes a failure in 
the secretion. 

If necessary the mother may be instructed as to the 
manner in which to give the child the breast. The child 
should lie on the right or left arm, according to whether 
the child is nursed at the right or left breast. If the 
mother is in a sitting posture her body should be inclined 
slightly forward. With her free hand she should gra.sp 
the breast near the nipple, between the first two fingers. 
If. owing to the too free flow of milk, the child takes the 
milk too rapidly, this may be checked by slight press- 
ure of the fingers. The child should nurse until satis- 
fied. The contents of one breast are generally sufficient 
for one nursing, and the breasts should be used alter- 
nately. When satisfied the child will usually fall asleep 
at the breast. Under ordinary conditions nursing should 
last from about ten to twenty minutes. If the milk is 
taken too rapidly, vomiting may ensue during or im- 
mediately after feeding. If too much is taken, it is 
regurgitated almost immediately. If the infant consumes 
more than half an hour in nursing, the breast and the 
milk should be examined. As the infant grows it 


requires and takes more food, and consequently nurses 
somewhat longer than in its earlier days. 

Good nursing habits should be insisted upon, as many 
attacks of indigestion, colic, and diarrhea may be traced 
to improper nursing. WJien good habits are estab- 
lished there is generally but very little trouble, the suc- 
cess of the training depending largely upon how it is 
done. Regular hours for feeding should be fixed and 
adhered to; If the child is asleep at the nursing hour it 
may be aroused, for it will almost invariably go to sleep 
ailer nursing. After the last feeding, which should be 
at 9 or 10 o'clock, the child should be quieted and 
allowed to sleep as long as it chooses. During the 
first month or two the infant will, as a rule, awaken be- 
tween I or 2 o'clock and again at 4 or 5 o'clock. After 
two or three months it will require but one night feed- 
ing, and after five months of age the average infant will 
sleep all night without nursing. 

When the change is being made and the child awakens 
for its accustomed nursing, it should be given a little 
warm water from a bottle and quieted but not taken up. 

The following table from Holt may be used as a guide 
in breast-feeding : 

Nun>h«- in 







ad day 


3a to 28th day 




3d IQ S'h month 

5th to 12th monlli 


If the child is small or ill it will run .somewhat behind 
the above schedule, and if it is large and robust some- 


what ahead of it. It is a good general rule to feed the 
child according to the age to which the child's weiglit 
corresponds. The child's weight is the best index to its 
nutrition. During the first few months it should be 
weighed twice a week, then once a week, and during the 
second six months twice a month. 

If the mother's milk is unsuited to the child it is fret- 
ful, the weight remains stationary or the child loses, and 
there may be bowel disturbances. In such cases the 
physician frequently examines the breast-milk to deter- 
mine its quahty, and he may either decide to wean the 
child or to take certain measures to improve the breast- 
milk. The following are the most frequent means of 
modifying the mother's milk : 

1. If the milk is too rich the diet should be limited, 
especially as to the amount of meat taken. All alco- 
holic and malted drinks should be prohibited. With 
plenty of fresh air and exercise, such as walking, the 
desired effect will generally be brought about. The should be carried to the point of fatigue. 

2. When the milk is good but deficient in quantity, the 
supply may be increased by massage of the breasts three 
times a day and from five to ten minute.s. A good malt 
extract should be given with the meals, plenty of milk 
should be given, and exercise and fresh air looked after. 

3. When the milk is deficient both in quality and 
quantity the above means should be used, and the phy- 
sician generally prescribes iron in addition, and special 
orders about the diet. 

4. When the quantity is norma! but the quality poor 
the same means should be tried, but these cases are prac- 
tically hopeless, and the physician usually decides to 
wean the child. 



Contra-indications to Maternal Nursing.— While it is de- 
sirable that the mother should nurse her child if possible, 
certain things do not permit it in the best interests of 
both mother and child. It is strictly the physician's 
province to decide this question, but it is well for the 
nurse to know that the following are the c on tra-indi ca- 
tions: I. If the mother has tubercu- 
losis in any form. 2. If the mother 
has had any serious complications, 
either with pregnancy or parturition, 
nephritis, convulsions, hemorrhage or 
infection. 3. If the mother has cho- 
rea or epilepsy. 4. If the mother has 
shown in two previous pregnancies 
that she is totally unable to nourish 
her child. 5. When no milk is se- 
creted nursing is impossible, but bear 
in mind that the milk-supply may be 
deficient because no care is taken to 
estabhsh it. 

{h) Wet-Nursing.— With the ad- 
vent of better methods of artificial 
nur-sing the wet-nurse is disappearing^ 
at least in the United States. Some 
infants will not thrive on any but human fig. 3 —a hyuieidc nu™- 
milk, and sometimes wet-nurses arc 
still employed. Their choice should always be super- 
vised by a physician. 

(f) Mixed Feeding:. — The physician may decide to 
give the child one or more bottles a day, while the milk 
is being established, if it is delayed beyond forty-eight 
hours, during illness of the mother, during weaning, 
and often one bottle a day is allowed to permit the 




necessary household or social 

mother to attend 

{li) ArtificialFeeding.— When it becomes necessary 
for the child to be fed on the bottle, the milk-mixture 
to be used should be prescribed by the physician, and 
the nurse instructed by him in its preparation. It hap- 
pens very often that many details are left to the nurse, 
and frequently even the entire matter. The following 
short account will help her understand what is expected. 
(Full details will be found in our larger book, " Diet in 
Health and Disease.") 

The average infant will not thrive on plain cows' milk. 
To render it more fit for digestion it is diluted with water, 
lime-water, cereal gruels, and other articles of diet. The 
necessity for this will be seen on considering the differ- 
ences between cows' and mother's milk. 

Proteins. — These differ in amount and character. 
Mother's milk contains 1.5 to 2 per cent, of protein, on 
an average. Of this two-thirds are lactalbumin and one- 
third casein, the latter being much more digestible than 
the former. In cows' milk there is about 3.5 per cent. 
protein, of which five-sixths are casein and one-sixth 
lactalbumin. The casein of mother's milk is coagulated 
in the stomach in small flocculent masses. Cows' milk 
is coagulated in large curds. The proteins of cows' 
milk may be prevented from forming large curds by the 
addition of lime-water, barley-water, and gruels. 

Sugar. — Milk-sugar is present in mother's milk in a 
very constant proportion of 6 to 7 per cent. In cows' 
milk it averages 4-5 percent. Milk-sugar must be added 
to the milk to bring up the amount, or sometimes cane- 
sugar is added. Owing to its excessive sweetness, cane- 
sugar is used in just half the quantity of milk-sugar. 



Tat. — The fat in human milk averages 4 per cent.; 
that of cows' milk is the same. When the cows' milk 
has been diluted, the quantity of fat must be made up 
by adding cream or using the upper part of the milk 
after the cream has risen, as explained beiow in the 
■' Top-Milk Method." 

Salts. — The inorganic salts in the milks vary in about 
the same proportion as the proteins. They need not be 
considered in modifying milk for babies. 

Beaction. — Mother's milk is always alkaline, uhile 
cows' milk is acid or neutral. This acidity must be cor- 
rected by adding 5 per cent, of lime-water. If the milk 
is to be sterilized at boiling-point, the lime-water should 
be added afterward, or else .sodium bicarbonate added 
in the proportion of 1 grain to the ounce. Coit uses 
potassium bicarbonate. 


There are a number of methods of modifying milk for 
infants, if it is necessary to do more than to make a 
milk approximate in character that of human milk. A 
young and feeble child requires small percentages of all 
ingredients, which may be increased gradually as the 
child's digestive powers increase. Rotch gives a table 
(p. 102) based on the experience of the Walker-Gordon 

Where the proteins are split, the result is obtained by 
using mixtures of whey and cream or milk. The whey 
is obtained by coagulating the casein with rennin or 
essence of pepsin (Fairchild's). 

I/aboratory Method. — In certain cities there are 
milk laboratories, known as the Walker-Gordon labora- 
tories, where physicians may send prescriptions for milk- 



mixtures, which are made at the laboratory and sent to 
the home of the infant. The only procedure is to re- 
move the cotton stopper from the bottle and replace it 
with a nipple and warm the milk. The Walker-Gordon 
Company also supply an ideally clean milk for infants' 

Theoretic Basis for Feeding a Healthy Infant. — Rotch. 




Ptotriiu if aplil. 






Dd^l/sdweek '. 

odDfjdweek . 
End or 4th week. 

nd of 6lh week . 
End of Sib week . 

nd of i^tfa week 

nd of 4lh month 


Endof i«h month 

EadoTiKh month 







Top-milk Method. — One of the most frequently 
used methods is that of Holt, known as the top-milk 
method. The milk \?. received in bottles and allowed to 
stand until the cream has separated. The mixtures are 
made up by using either the upper third, upper half, or 
the whole milk. To remove the top milk, the first ounce 
is taken off with a spoon and the remainder taken out 
with a Chapin milk-dippcr, poured off, or a siphon used 
to remove the milk from underneath it. Lime-water, 
sugar, and the required quantity of water are added. 
The following formulas are taken from Holt's book : 



First Series of Formulas — Fat to Froteids, 3 : i. 

Primary Formula. — Ten per cent, milk — fat, 10 per 
cent.; sugar, 4.3 per cent. ; proteids, 3.3 per cent. Ob- 
tained — (1) as upper one-third of bottled milk or {2) 
equal parts of milk and 16 per cent, cream. 

Derived furmulas, giving quantities for 20-ounce mix- 
tures : 

{Milk-BUgar . 
Lime-waler . 
Water, q.s. ail. 2 



Table Giving in a Condensed Form the Quantities Usually 
Required for Obtaining the Different Fat-percentages. 


Proteids : The perceiit^e in each case will be one-third fat. 

Sugar; I ounce in 20, or I loblespoonful in 8 ouoces, gives 5.5 per 
cm. Tor ibe lower and 6.5 for llie higlier formulas. 

I.ime-waler : I pan to 20 of ihe food, [he average required. 

Water : Suflicienl to l.e added to Ihe foregoing ingredients to bring ihe 
Dtal lo Ihe number of ou.icea specified; in part ctf Ihis water the miik- 
ugar is dixsolved. l!ar!cy-waler or any olber diluent may be added in 

Second Series of Formulas — Fat to Proteids, 2 : i. 
Primary Formula. — Seven per cent, milk — fat, 7 per 
cent. ; sugar, 44 per cent. ; proteids, 3.5 per cent. Ob- 
tained— (i) as upper one-half of bottled milk, or (2) by 
using 3 parts of milk and i part 16 per cent, cream. 


Derived Formulas^ giving quantities for 20-ounce mixt- 

I. ■< Lime-water . I oz. [-with 

{Milk-^ugar . I oz. 
Lime-water . I oz. 
Water, q.s. ad. 20 oz. 

( (( K 

« li 





per cent. 

per cent. 

per ct. 

3 oz. 



. 1. 00 



. 4 oz. 



• 5.75 


5 oz. 





6 oz. 





7 oz. 





8 oz. 





9 oz. 





10 oz. 









(Milk-sugar . } oz. 
Lime-water . i oz. [- " 12 oz. " ** 4.00 7.00 2.00 

( Water, q.s, ad. 20 oz. 


Table Giving in a Condensed Form the Quantities Usually 
Required for Obtaining the Different Fat-percentages, 


To obtain fat per cent, j.o i.o 1.4 1.8 2.0 2.33 2.75 2.75 3.1 3.5 3.5 4.0 4.0 
For total food, ounces 20.0 30.0 30.0 33.0 33.0 36.00 36.03 40 00 40.0 40.0 44.0 44.0 48.0 

Take 7 per ct. milk, ) g ^ g^ ^^^ ^^.00 14.00 16.00 18.0 20.0 22.0 25.0 a8 o 

ounces J 

To obtain the exact fat-percentage, take one-third the number of ounces 
of top-milk in a 20-ounce mixture and add 0.15 to the result. In practice 
this slight error may be disregarded. 

Proteids : The percentage in each case will equal one-half of the fat. 

Sugar : I ounce in 20, or I even tablespoonful in 8 ounces, until the 
food 1)ecomes half milk ; after that I ounce in 25, or i even tablespoonful 
to each 10 ounces of the food, will give the proper amount. 

Lime-water : Usually in the proportion of i part to 20 of the total 

Water or other diluent : Sufficient to be added to the foregoing ingre- 
dients to make the total number of ounces specified ; in part of this the 
sugar is dissolved. 

Third Series of Formulas — Fat to Proteids, 8 : 7. 

Primary Formula. — Plain milk — fat, 5 per cent. ; sugar, 
4.5 per cent. ; proteids, 3.5 per cent. 


Derived formulas, giving quantities for 20-ounce mixt- 

fMLlt-sngar . 1 oi, ) pcrtc'ni., va Ji- 

Limc-waler . 1 oj. [ witli S 07. plain milk . I.OQ 6.0O o.S; 
Waler,q.s. ad. 20 (n, J 

r Milk-sugar \ o' 

Table Giving Quantities of 16 prr cent. Milk Required for 
^ Formulas with High Fat and Low Protetds. 



Proteids in kU rases will be one-Jirth tbe fal. 

Sugar : t even tableapoonful for each S ounces will give 5.5 per cent, 
for the lower fomulas (A, B, C, elc.) and 6 per cent, for the higher for- 
mulas (O, H, I, elc.). 

Linie-wiiler : 1 ounce to 20 ounces of the faod will give 5 per cent, 

Matema Graduate Method. — Where a nurse is 
thrown on her own responsibility, the Estraus Matcrna 
Graduate is of great service. With it six modifications 
can be made, which are sufficient for the average child. 
Sometimes, of course, a child will be found whose diges- 
tive powers do not correspond with the few formulas 

The apparatus consists of a glass jar with a lip and 
seven panels, and a capacity of i6 ounces. One of the 
panels exhibits an ordinary ounce graduation ; the other 
six panels present six different formulas for the modifica- 
tion of cows' milk, each formula being so arranged as to 
keep pace with the infant's growth, viz. : 



Fat . .2 per 
Sugar . 6 ' 
Protein 0.6 ■ 

For Furmala 6 see special ii 



3} per cent. 4 per cenL 3 j per ct 
7 " 7 " 3i " 







Milk parts 

Cmini .... " 

LIiM-wmler . . " 




Barity-^ti ; " 



Having decided which formula is to be used, the panel 
containing that formula is the only one to be followed. 



The quantity desired for twenty-four hours is next to 
be considered, and the apparatus filled — once, if 16 
ounces or less are required for the twenty-four hours; 
twice, if from 16 to 32 ounces are required for the twenty- 
four hours; three times, if from 32 to 48 ounces are re- 
quired for the twenty-four hours. 

Banei's Method. — If the percentages have been given, 
the quantities of milk, cream, sugar and water needed 
may be determined by the following formulas : 

Quantity desired (in ouiic 
Desired perceofage of fal 
Desired percentage of sug: 
Desired percentage of pral 


Dry milk-sugnr = " '. 

Example. — Suppose it is desired to make 40 ounces 
of a 4 per cent, fat, 7 per cent, sugar, 2 per cent, pro- 
tein mixture. By substituting the figures in the equa- 
tions above we have — 

Cream =1% i = 6= ounces. 

Milk =4?.^-^6j = i3i ounces. 

Water =40-20 = 20 ounces. 

Sugar -5M9=aounces. 

Malted gruels, various diastase preparations, such as 
diastoid, maltine and diazyme, as well as the malted 
foods, such as Mellin's, are sometimes used to prepare 
the infant's milk, especially if there is constipation. Bar- 

1 08 


ley-, oatmeal-, and rice-water are sometimes used to 
dilute the milk to break up the curd. Barley- or rice- 
water is preferred when there is a tendency to loose 
bowels, and oatmeal-water when there is constipation. 
Cereal gruels are probably best not begun before the 
eighth or ninth month, unless there be .some special 
indication for so doing. 

Beginning Bottle - feeding. — The percentages 
should be low at first, far below what would be given 
the child if it were accustomed to cows' milk. As soon 
as the infant's stomach is accustomed to the milk, it 
should be rapidly increased in strength until the proper 
mixture for the child in question is reached. 

Technic of Modifying Milk at Home. — Great 
care and cleanliness should be used. The vessels and 
instruments used should, if possible, be kept solely for 
the use of the infant. AI! bottles, pitchers, and other 
utensils should be thoroughly boiled or scalded before 
using. The nursing-bottles should have rounded bot- 
toms, to facilitate cleansing. It is a good plan to keep 
the bottles sweet by filling them with a solution either 
of boric acid or sodium bicarbonate, a teaspoonful of 
either drug to a pint of water. The nipple should be 
ordinary short black rubber ones and white rubber, and 
all nipples with tubes or complicated structure avoided, 
as they are hard to clean and are liable to lead to bowel 
troubles. It is a good plan to have several nipples on 
hand, and to boil them when first bought, and once a day 
afterward. They should be thoroughly washed after 
e.ich using, turning them inside out for that purpose, 
and kept in a .solution of boric acid or sodium bicarbon- 
ate. The milk should drop rapidly when the bottle is 
held upside down. If it does not run fast enough, the 



holes in the nipple should be enlarged by using a red- 
hot darning-needle. If the fiow is too free it may cause 
vomiting, and such nipples should be rejected. 

It is best to prepare the entire quantity for the twenty- 
four hours at one time. If the weather is warm the milk 
should be either sterilized or Pasteurized, unless an ex- 
ceptionally pure milk is being used. If neither can be 
done, thefeedings maybe prepared one at a time as needed. 

The sugar, either milk or cane, is dissolved in hot 
water. If the solution is not perfectly clear, it should 
be filtered. This is poured into a pitcher with the lime- 
water or the soda, and the milk or milk and cream and 
other ingredients, if any have been ordered, should be 
added. After oiixing, the nursing-bottles arc filled with 
the proper quantity for each feeding, and the bottles 
stoppered with sterile raw cotton. The bottles are then 
sterilized or Pasteurized as directed, and then, after rapid 
cooling, are placed in the refrigerator. At the feeding- 
hour the bottle is heated and a nipple substituted for the 
cotton stopper. 


During the second year of life as much care is required 
in feeding as during the first. The fear of tiie second 
summer would largely be overcome if the child were 
not allowed to eat food unsuited to its digestion. The 
fact that some children thrive on almost any kind of food 
is no excuse for permitting a child to have the same 
food as its elders, as is so often done. Most of the ill- 
ness and many of the deaths of childhood are traceable 
to improper diet. 

During the second year milk should form the basis 
of the diet. In cities or where the milk-suppIy is not 



above suspicion, it is best to Pasteurize the milk until 
the second summer has been passed, or even longer if 
circumstances warrant. As a rule, the milk requires but 
little modification, and after the eighteenth month, and 
often before, may generally be taken unmodified. As the 
child is now able to digest starchy food, milk-sugar may 
be omitted. In cases where the milk is not thoroughly 
digested, as is evidenced by curds in the stools, hme- 
water may be used, and may be added in quantities of 
from 5 to iO per cent, or even more if necessary. If the 
milk is very rich, it should be diluted cither with lime- 
water or usually with plain -sterile water — three parts of 
milk to one of water. If the milk is poor or if milk 
that is not rich does not agree with the child, it may be 
prepared as follows: Fill a glass three-quarters full of 
milk, add one or two tablespoonfuls of cream, and fill to 
the top with plain water. If this does not answer, add a 
tablespoonful of lime-water. During illness, and often 
under other circumstances, the alkaline carbonated waters 
will be found useful for diluting the milk. If the milk 
is poor, another plan is to use the upper two-thirds of 
the milk. 

Starchy food may be given in the form of gruel, either 
alone or, what is better, mixed with the milk. Barley- 
gruel or, if there is a tendency to constipation, oatmeal- 
gruel is added, one-fifth or one-fourth part of gruel being 
added to each feeding. The gruel .should be freshly pre- 
pared and mixed immediately with the milk. A pinch 
of salt and a very small quantity of cane-sugar may be 
added to render it more palatable. It may then be Pas- 
teurized like ordinary milk. 

During the second year five meals at about four-hour 
intervals should be given. The bottle should be dis- 


petised with and the food be taken from a cup or spoon. 
If the bottle is not taken from the child early, it may be 
difficult to break it of the bottle habit. The following 
diet-lists for different ages will be found useful : 

Twelve to Fifteen Montlis. — Milk, barley-, oatmea!-, 
wheat-flour-, farina-, or arrowroot-gruei ; barley- or oat- 
meal-jelly ; lightly boiled yolk of egg, given with stale 

Beef-, mutton-, or chic ken -broth, chicken-jelly, beef- 

Orange-juice or the juice of other ripe fruit, as of 

First Meal. — On waking, the child should receive a 
cupful of warm milk, modified as previously suggested. 
If the child is accustomed to waking very early, more 
miik may be given at about 7 a.m.; otherwise this last 
may be regarded as the first meal. 

Second Meal, 10.30 a.m. — Eight ounces of warm milk 
and barley-gruel. 

Third Meal, 2 P.M. — One of the following : 

(a) EiLjhl m 

nces (a cupful 

of becf-brclh. 

(*) " 


" vcal-brolh. 

(.) " 

■ mul.on-brot!i. 

(,/] " 


■■ chickeii-brolh. 

(.■) Yolk of 

lightly hoile. 

egg with sule bread-crumbs 


Fourth Meal, 5 p. h. — Eight ounces of milk and barley- 

Fifth Meal, 10 p.m. (if required). — Eight ounces of 

Orange-juice, one or two tablespoonfuls at a time, may 
be given for one hour before the 10.30 A. m. feeding. 
If there is a tendency to loose bowels this should be 


If the child's appetite is very good a small piece of 
zwieback may be given with either the second or the 
fourth meal. This should not be soaked in the milk, but 
the child should be allowed to nibble at it dry. 

Fifteen to Eighteen Months. — Same as above, together 
with zwieback, stale bread (oven-dried), whole eggs very 
soft boiled; strained oatmeal, barley, or wheat-porridge; 
bread and milk, thin biscuit (crackers), junket, scraped 
raw beef or mutton jn very small quantities. 

A Sample Diet for a ChUd of Fifteen to Eigliieen 
Months. — Breakfast, 7 a. m. — Either («) two tabtespoon- 
fuls of a cereal jelly (oatmeal or other grain as desired), 
with salt and two tablespoonfuls of cream, and eight 
ounces of milk to drink ; or {b) a bowl of bread and milk 
containing eight ounces of milk and a shce of stale bread. 

Second Meal, 10.30 A. M. — Milk, with a cracker or thin 
slice of .-itale bread or a piece of zwieback. 

Third Meal, 2 p. m.— One of the following; {a) Very 
soft-boiled egg with stale bread-crumbs, {b) Eight 
ounces of broth (beef, veal, mutton, or chicken) with 
stale bread-crumbs or a little barley added to it. (r) A 
tablespoonful of mashed baked potato with meat-broth 
or gravy (one to two ounces), or with two tablespoonfuls 
of cream. Milk to drink, {d) Scraped raw beef or 
mutton, two or three tablespoonfuN on a "banquet 
wafer," with a cup of milk. A tablespoonful of junket 
may be added to any of these. 

Supper, 5.30 or 6 p.m. — Eight ounces of milk with a 
piece of zwieback, a slice of stale bread, or a cracker or two. 

Fifth Meal, 10 p. m. (if needeif). — Cup of milk. 

Fruit-juice may be given, as previously directed. Eggs 
should not be given oftencr than twice a week, as children 
tire of them easily. 


Eighteen Months to Two and One-Half Years. — Milk is 
to be regarded as the chief article of diet. Many chil- 
dren have no desire for other foods until the second or 
third year. These children will generally be found to 
thrive on milk alone or with slight additions to tlie diet. 
As the child's digestive power increases, the following arti- 
cles may, however, be added one at a time : 

Fruit. — Juice of ripe fresh fruit, that of oranges and ■ 
peaches being best. Ripe fresh grapes skinned and 
seeded. Baked apple — pulp only, the skin and seeds to 
be carefully removed. Stewed prunes, the skins to be 
removed by passing through a sieve. 

Meats. — Scraped raw beef or mutton ; rare roast beef 
or mutton pounded to a pulp. Chicken or turkey, the 
lean white meat minced to a pulp. 

Vegetables. — Mashed baked potato with cream or cov- 
ered with gravy from roast meats. If the latter is very 
fat, the fat should be removed by skimming or by means 
of a piece of blotting-paper. Very well -cooked spinach, 
celery, and cauliflower tops. 

Cereals. — Well-boiled rice and other well-cooked cereals 
already mentioned. 

Desserts. — Boiled custard, milk- and rice-puddings, 

Four meals will generally suffice after the eighteenth 
month. The following dietary will serve as a sugges- 
I tion: 

If the child wakes early, a cupful of warm milk (six 

Breakfast, 7 A, m. — (a) Four tablespoonfuls of oatmeal- 
porridge or other cereal with salt and two tablespoonfuls 
of cream ; milk to drink, (^) Yolk of a lightly boiled 
egg with salt and bread broken into it ; milk to drink. 



Second Meal, 10.30 A. m, — Cup of milk with two soda 
biscuit's (crackers), slice of bread, or a piece of zwieback. 

Dinner, 2 v. M. — One of the following : {a) A bowl 
(eight ounces) of meat-broth with rice, barley, or bread- 
crumbs added to it. Slice of stale bread; junket or 
rice- or milk-pudding, {h) Tablespoonful of white meat 
of chicken or of rare beef or mutton, either scraped 
or pounded to a pulp. Slice of stale bread thinly but- 
tered, junket, rice- or milk-pudding, or a boiled custard. 
((■) Perfectly fresh boiled fish (the white meat) with a 
tablespoonful of mashed baked potato moistened with 
cream. Dessert as in preceding. 

Supper, 5.30 cr6 p. M. — A bowl of bread and milk or a 
cup of miik and a slice of bread or a piece of zwieback. 
A cup of milk may be given at about 10 p. m. if necessary. 

From two and one-half years up to the sixth year the 
diet of the child may gradually be increased. Milk 
should still, however, be taken in large quantities — about 
a quart daily — as well as some form of cereal for break- 
fast, with or without an egg, or fresh fruit if there is a 
tendency to constipation. Meat prepared as above 
should be given once a day, and preferably at the mid- 
day meal, together with potato and some green vege- 
table, as spinach, asparagus, or cauliflower tops. The 
evening meal should be light, and consist of bread and 

The Diet from Two and Oae-half to Six Years. — Milk 
may be allowed with every meal (may be omitted from 
dinner if desired). The average child should take a 
quart a day, plain or. when plain milk is not thoroughly 
digested, modified as for twelve to fifteen month.s. 

Cream, — Two to eight ounces a day mixed with the 
milk, taken as a beverage, with cereals, etc. 


Bread and biscuit may be allowed with every meal — 
stale bread, dried bread; the so-called "pulled bread," 
zwieback, and the various forms of biscuits or crackers. 

Cereals. — Almost any kind of ccrea! for breakfast; 
oatmeal and wheaten grits are the best. Rice and 
hominy for dinner. Barley is useful in soups. 

Vegetables may be allowed for dinner — potatoes in 
some form or a cereal with one green vegetable; spinach, 
cauliflower tops, and the hkc arc the best. 

Eggs are very good, but children are apt to tire of 
them easily. They should be given for breakfast, as a 
rule, but never day after day. 

Meat. — Allowed once a day for dinner, and in older 
children for breakfast occasionally. Boiled or broiled 
fish may be given for breakfast or dinner. 

Broths and soups of simple composition may be eaten. 
Meat-broths with cream and cereals are especially nutri- 

Desserts. — Once a day. with dinner. Plain custard, 
milk- and rice-pudding, bread- and custard-pudding, and 
junket arc the best; ice cream once a week. Fruit 
should be given once daily, and only ripe fresh fruit, in 
season, should be used. The best are oranges, baked 
apples, and stewed prunes. Ripe peaches, pears, grapes 
without skins or seeds, may also be given. Fresh juice 
of berries in small quantity, strawberries in perfect con- 
dition sparingly. Ripe cantaloupe and watermelon in 
moderate quantities may also be allowed. Great care 
should be used in choosing and giving fruit to children. 
It is a very important article of diet, but if stale, spoiled 
or unripe, is capable of doing much harm. Too much 
should not be given in hot weather. Lemonade is useful 
during very hot weather. 



According to Meals. — Breakfast. — Every day, milk 
to drink. A well-cooked cereal with salt and cream, 
but little or no sugar. Bread and butter. 

In addition to the above, one of the following every 
day : Eggs lightly boiled, poached, and for older children 
scrambled or made into a plain omelet. Boiled or 
broiled fish. For older children a very little finely 
chopped beef, mutton chop, or beefsteak. For younger 
children meat at breakfast is not, as a rule, necessary. 
Fruit may be given before or after breakfast, during the 
latter part of the morning, or at about noon — one 
variety daily; and if there is a special tendency to consti- 
pation, stewed prunes or baked apples may be allowed 
with the dinner, but not on the days on which they have 
been used earlier. Oranges, baked apples, stewed prunes, 
peaches, pears, grapes without seeds or skins; ripe 
apples (the softer varieties may be given ; those known 
by the dealers as " hard" apples are not suitable unless 
cooked) are the most suitable. 

Dinner. — Bread and butter as desired eveiy day — 
not to be eaten to the exclusion of other foods, how- 

One soup each day.- Bouillon, beef, veal, mutton, 
chicken, or oyster-broth, which may be thickened with 
barley or other cereals (either grain or flour). Milk and 
cream may be added where desirable. 

One meat daily — roasted or broiled. Beefsteak, beef, 
Iamb or mutton chop, rare roast beef or mutton, chicken 
(white meat) or roast turkey. 

Two vegetables dnih— one green vegetable and one 
other dish, usually potato in some form, should be given. 
Potatoes, baked or mashed, cauliflower tops, asparagus 
tips, stewed celery, spinach, hominy, plain macaroni. 


mashed peas, young string-beans, and almost any green 
vegetable in season. 

Dessert. — junket is the best and maybe given most 
frequently, but rice- and milk-pudding, plain custard 
and plain tapioca-pudding may also be used in small 
quantities. Ice cream once a week. Fruit in some cases 
may be used. 

Slipper. — Very light simple suppers should be given 
every day. Milk, milk-toast, bread and butter, and, for 
older children, a little stewed fruit or baked apple with- 
out too much sugar. 

Articles Fokbidden (after Holt). — The following 
articles should not be allowed children under four years 
of age, and with few exceptions they may be withheld 
with advantage up to the seventh year. 

Meats. — Ham, sausage, pork in all forms, salted fish, 
corned beef, dried beef, goose, game, kidney, liver, bacon, 
meat-stews, and dressing from roasted meats. 

Vegetables. — Fried vegetables of all varieties, cabbage, 
potatoes (except when boiled or roasted), raw or fried 
onions, raw celery, radishes, lettuce, cucumbers, toma- 
toes (raw or cooked), beets, egg-plant, and green corn. 

Bread and Cake. — Ail hot bread and rolls ; buckwheat 
and all other griddle cakes ; all sweet cakes, particularly 
those containing dried fruits and those heavily frosted. 

Desserts. — All nuts, candies, pies, tarts, and pastry of 
every description; also .salads, jellies, syrups, and pre- 

Drinks. — ^Tea, coffee, wine, beer, and cider. 

Fruits. — All dried, canned, and preserved fruits ; 
bananas; all fruits out of season and stale fruits, pai- 
ticularly in summer. 

The meals should be given at fixed hours, which prac- 


tice should be strictly adhered to. Feeding between 
meals, even when consisting of the most trilling things, 
should be avoided. If the child cannot go from one 
meal to another without discomfort, the intervals should 
be shortened. In certain cases it may be advisable to 
give a small cup of milk or broth and a cracker between 
the meals, at stated intervals, as in feeding younger chil- 

Candies, cake, and the hke should be kept from young 
children. In well -regulated homes, if he once learns 
that he can not have them, the child will soon cease 
to demand sweets. The frequent indulgence in sweets 
of various kinds creates a de.sire for them to the ex- 
clusion of other food. This craving is analogous to 
that for alcohol in adults. Overindulgence in sweets 
causes indigestion, headache, and the like, ailments that 
may easily be prevented. 

The child should be taught to eat slowly and to chew 
the food well. To this end, some older individual should 
always be present at meal-time to see that sufficient 
time be taken for the meal, and that the food be finely 
divided, as young children do not, as a rule, chew very 
well. The quantity given to a healthy child should depend 
on his appetite. In sick children this is not a reliable 
guide, and where possible fixed amounts may be given. 
The child should not be forced to eat, nor should he be 
given special articles to tempt the appetite. If the food 
offered is not taken, it is well to wait until the next meal^ 
when it will generally be found that the appetite has 
returned. Loss of appetite is often merely an indication 
that the digestive organs require a slight rest. 

During the heated portions of the year the child will 
require less sohd and more liquid food. The same is 



true during sickness. Many of the gastro-intestinal dis- 
turbances attributed to teething are the result of improper 


The period usually spoken of as "school days" is an 
extremely active one physically. The vast number of 
metabolic changes going on and the growth of the body 
demand a plentiful and a suitable diet. Both in and out 
of school and in seminaries careful attention should be 
given to food, fresh air, and exercise. In other words, 
the physical development should receive as much atten- 
tion as the mental growth. In boarding-schools espe- 
cially the diet should be the subject of careful study, the 
aim being to avoid monotony and to provide a sufficient 
and satisfying diet. In many schools the dietary is left 
to the discretion of the cook. In considering school 
dietaries several points are worthy of consideration. 

Milk, being easily digested in most cases, is of great 
value, especially for children whose nutrition is below 
normal. It should be furnished as a beverage daily for 
breakfast and supper, and is advi.sable even with dinner. 
It may also be used in the preparation of puddings and 
soups. Cream is very valuable, and whenever possible 
should be supplied in sufficient quantities. A cup of 
warm milk with bread or crackers is helpful during the 
middle of the morning and as a substitute for tea in the 
afternoon. Delicate children and others may with advan- 
tage take a glass of warm milk a short time before going 
to bed. If the rising hour is some time before that set for 
breakfast, a cup of milk or of bread and milk should be 
given on rising. 

Eggs may be used alone or in the preparation of vari- 
ous dishes. They may be used in almost any way except 



fried. Fried eggs are apt to be very indigestible. They 
are often prepared in this way in order to disguise tlic 
stale taste of an egg that has been in storage for some 

Meat is a very important part of the diet, as it con- 
tains a larger quantity of protein, from which the tissues 
are built up, and in a more available form, than in any other 
form of food. Milk and eggs are also valuable sources 
of protein. Meat should be provided, therefore, in suffi- 
cient quantities, a half-pound a day being, perhaps, a 
good average allowance for a growing boy, the larger 
and more robust taking that quantity or more, the smaller 
and more delicate children taking somewhat less. Steak, 
chops, and roasts of beef mutton, lamb, fowl, and bacon 
are the most suitable meats, although pork, together 
with meat-stews, meat-puddings, sausage, and hashes, 
may be allowed in smaller quantities. These last, while 
generally relished, are not so digestible nor such good 
sources of nutriment as those first named. With care 
and proper preparation many of their ill effects can be 
obviated. More meat is required in winter than in sum- 
mer, and more in cold climates than in warm. Yeo states 
that too much meat may give rise to eczema. 

Meat may be given twice a day, and eggs or fresh fish 
may be substituted for it about three times a week. When 
these do not satisfy the appetite, meat may be added. 
For this purpose cold sliced meat is useful. 

Bread and butter should be given with each meal. 
Bread made from the whole-wheat flour may be used in 
the largest quantity, but it is well to supply various kinds 
of bread, to avoid monotony. "Brown bread" given 
continuously becomes very tiresome. Rye-bread may 
be given occasionally, and bread made from mixtures of 


wheat and rye is very palatable. Rusk, biscuit, and 
crackers may also be supplied. Corn-bread, when prop- 
erly made, may be given once a week or ofcener, and 
griddle cakes of buckwheat, corn, or wheat flour two or 
three times a week. These last may be served with 
syrup or fruit-juices. 

Cereal porridges of all kinds may be given for break- 
fast, oatmeal being probably the most desirable. 

Vegetables of almost all varieties may be used. For 
dinner two varieties should be given, one green vegetable 
and potatoes. Salads made of the green vegetables, 
with the very simplest dressings, are useful additio 
the diet. 

Fruit should invariably be given once a day. 

Sugar should be provided for in the dietary. Candies 
and many of the sweets given to children are harmful and 
cause indigestion and dyspepsia. If proper sweets were 
provided there would be slighter tendency to indulge in 
the less desirable forms whenever opportunity offered. 
With the meals, and when the appetite demands satisfy- 
ing between meals, they may be given with or without 
a glass of milk. Regularity should, however, be ob- 
served, and they should not be given immediately before 
or after a meal. Fruit-syrups, sugar-syrups, honey, pre- 
served fruits, and jam may be eaten with bread. Cara- 
mels, chocolate, maple-sugar, and plain sugar-taffies are 
the best of the other forms of sweets. 

Simple desserts, such as custards, milk-pudding with 
rice, tapioca and the like, bread -pud ding, plain cakes, 
and properly prepared pastry may be used. 

The beverages should be water and milk. Weak cocoa 
or chocolate may be given after the seventh year. Tea 
and coffee should not be given before the thirteenth year, 


and may be withheld advantageously still longer. Alco- 
hol is not to be used except by a physician's direction. 

Especial care should be taken to avoid a monotonous 
diet, for there are many instances where the constant 
repetition of a certain form of food has created a dislike 
for it that has persisted throughout life or been overcome 
only with difficulty. 

A second point to be remembered is that the food 
sJiould be well prepared and attractively served. This 
ha.s more to do with influencing the appetite of delicate, 
nervous children than is generally supposed, and can not 
be insisted upon too strongly. 

Overeating should be avoided, and to this end an older 
person should always be present when practicable; in 
school, this should be insisted upon. On the other 
hand, a child should not, through caprice or habit, be 
allowed to eat too little. By exercising a little tact, most 
of the dislikes which are not deeply rooted, but which 
may become so if persisted in, may generally be over- 
come. These dislikes are often the result of imitation. 

Sufficient time should be allowed not only for the 
meal, but for the performance of whatever small duties 
may be required of the child. A time should be set for 
one or two regular daily visits to the water-closet. Hur- 
rying to school should be avoided. Reading and study- 
ing immediately before and after meals should be pro- 
hibited, as should bathing or any very active exercise. 
Some light form of recreation may, however, be indulged 
in. The hours of meals should be so arranged that the 
child may have freshly prepared meals, and not cold 
luncheons or warmed-over dinners. Lastly, nibbling and 
eating between meals, except under the conditions pre- 
viously described, should be strictly prohibited. In spite 

I an 


of stringent rules, however, many infringements will 


It is by neglect of the diet, fresh air, and exercise that 
many cases of tuberculosis gain headway ; anemia may 
result from such neglect, and a delicate, nervous child be 
the outcome of one that should, by right, be healthy. 


The feeding of infants in overcrowded infant asylums, 
with their lack of fresh air and paucity of attendants, is 
a matter of great difficulty. Any attempt at scientific 
feeding under such circumstances will ultimately lead to 
failure, the method in these cases being held to blame. 
The primary cause of malnutrition and marasmus in in- 
stitutions is the lack of fresh air and individual care, and 
until these are obtainable it is useless to attempt to ac- 
complish anything by special feeding methods. In the 
smaller institutions the use of the Materna graduate will 
be found satisfactory. 

In the larger asylums it is well to have two or three 
general working formulas, such as fat 3 per cent,, sugar 

6 per cent., protein 1 per cent.; and fat 4 per cent., sugar 

7 per cent, protein 2 per cent. These may be varied 
by adding more or less water to them to adapt them 
more closely to special needs. The younger infants may, 
when possible, receive special mixtures. For .sub.'ititute 
feeding, condensed milk, barley- and egg-water will be 
found most useful. 

The allowance of a few cents a day generally made for 
an infant's entire care is entirely inadequate to accom- 
plish any good. 



Stationary Weight ; I^ss of Weight.— The best 
index of nutrition is the weight of tlie child. If there 
is a stationary weight or the child loses weight the phy- 
sician should be informed at once, as it may mean serious 
trouble. If neglected it may change an easily managed 
condition into an irremediable one. Panopeptone or 
Liquid Beef Peptonoids or similar preparations are fre- 
quently ordered for such children, and changes of various 
kinds made in the feeding. 

Colic. — This is more frequent in breast-fed than in 
artificially fed children, and is most liable to occur dur- 
ing the first three months. In breast-fed children it may 
sometimes be due to the mother's milk being too rich, 
and measures are frequently prescribed to relieve this. 
The nursing intervals may be lengthened, and a little 
warm water given before each feeding to dilute the milk. 
In bottle-fed babies colic is most frequently due to the 
milk containing too much protein. It may also be caused 
by giving the milk too cold. Colic may be due to cold 
feet, chilling of the abdomen, and numerous other causes 
which have no relation to the diet. 

Vomiting.— Vomiting occurring immediately after 
feeding is usually due to the child's taking too much 
food or the taking it too rapidly. Vomiting may be 
caused at any time by the abdominal binder being too 
tight, from shaking the infant or holding with the head 


over the nurse's shoulder, or from patting on the back. 
Vomiting may occur at any time when the milk is too 
rich in proteins. It may be caused by coughing, and it 
is also a frequent symptom of many diseases. Vomiting 
one or two hours after feeding is usually due to the milk 
containing either too much fat or too much sugar, or 

Gavage. — Gavage, or feeding by means of a stomach- 
tube, is a method used in various diseases and conditions 
of infancy and childhood. In cases where the child is 
not able to take nourishment, or only in insufficient 
amount, and in cases of uncontrollable vomiting, this 
method may be resorted to. It is u.sed in the feeding 
of premature infants, whether in an incut>ator or not, and 
in cases of small, weak, marantic infants who, owing to 
weakness or lack of appetite, do not take sufficient nour- 
ishment. It is also employed after surgical operations 
about the head or neck where swallowing is interfered 
with, and in acute diseases, such as pneumonia, in fevers, 
and in delirium or coma. 

The results that follow this method of feeding are 
surprising, especially in cases where there is constant 
vomiting or where the stomach has a very small capacity. 
In the former case, the vomiting may cease and the food 
be retained ; in the latter, the capacity of a stomach that 
previously held only an ounce or two may rapidly be 
increased until an average-sized feeding is retained with 

The technic of the method is simple and the procedure 
conducted without difficulty in children under two years 
if age ; above that age it may be difficult, and a mouth- 
gag may be required; in some cases nasal feeding must 
be substituted. The apparatus employed is the same 


that is used for washing out the stomach ; and since it is 
frequently desirable to wash out the stomach before in- 
troducing the meal, the same tubing may serve for both 
purposes. It consists of a soft-rubber catheter, con- 
nected by means of a piece of glass tubing to a piece of 
rubber tubing, to the other end of which a funnel is 
attached. The nurse holds the child in her lap, with the 
head held straight and not inclined in either direction. 
The catheter is moistened with warm water and held 
several inches from the end, so as to allow enough of it 
to pass into the esophagus with the first attempt at intro- 
duction. The mouth is opened, if necessary, and the 
catheter passed rapidly into the pharynx; there is usually 
a swallowing movement, and the tube is readily passed 
into the stomach. If the procedure is carried on too 
slowly the tongue may interfere; or if the catheter is 
held too near the end, it may cause gagging. Before in- 
troducing the food it is well to wash out the stomach 
with normal salt solution. As soon as all the food has 
entered the stomach, the catheter is pinched and rapidly 
withdrawn. If it is withdrawn slowly the food may 
come up with the tube. If the catheter is left open as 
it is withdrawn, the dripping into the pharynx may cause 
vomiting. If the child is young, it is a good plan to 
keep the finger between the jaws for a few moments, to 
prevent gagging. If the food comes up the feeding 
must be repeated. 

Nasal Feeding-. — For thi.s purpose a catheter in 
proportion to the size of the child should be used. The 
procedure is the same as that for adults. 

Feeding- in Inflammations of the Month. — The 
food should be liquid or semisolid, and as bland and 


unirritating as possible. If it is not taken readily it 
should be given cold. 

Diseases of the Stomach.— Where there is marked 
vomiting and evidence of disease of the stomach milk 
should be withheld, and the patient given plain boiled 
water or albuniiu water in small quantities until the 
physician gives his orders concerning; the feeding. 

Diarrhea in Infancy and Childhood. — In a child 
under two and, indeed, even in older children, one can 
never say at the outset whether a diarrhea will be mild 
or severe. It is therefore well to diet all cases as if they 
were of a virulent type. By so doing many lives will be 
saved and much suffering avoided. About 97 per cent, 
of the deaths from diarrhea occur in bottle-fed babies, 
and the majority of these in the hot weather. 

In breast-fed children a diarrhea in winter is usually 
a mild one, and merely lengthening the nursing periods 
to six. hours and giving barley, rice, or albumin water in 
the intervals at the feeding times is all that is needed. 
After a day or two of this, together with the proper 
medical treatment, the child can generally resume its 
customary schedule. 

In summer, however, a diarrhea, especially if severe, 
should arouse suspicion, and for twenty-four hours, or 
until the child's condition warrants, milk should be with- 
held. The breasts should be pumped out carefully at 
regular intervals, to prevent distress or a possible cessa- 
tion of the secretion. The child should be given plain 
boiled water, or some of the articles previously men- 
tioned, at frequent intervals and in small If there 
is great thirst, one or two teaspoonfuls should be given 
every fifteen or thirty minutes. If fluid is well retained, 
several ounces may be given at a time, at intervals of 



two or three hours. Stimulants are often ordered, or 
small doses of the liquid beef preparations may be tried, 
such as Panopeptone, Liquid Beef Peptonoids, tonic beef 
and similar preparations, diluted and given cold. Small 
doses should be given, and if these foods are diluted 
sufficiently the laxative action they are supposed to e.xert 
will not be obtained. If by the second day vomiting ho-s 
ceased and the child seems better, it may be put to the 
breast for a few minutes and the effect noted. If the 
milk is well borne the child may be given the breast 
every six hours, shortening the interval from time to 
time until the child has returned to its regular schedule. 
It is well to make a gradual return, and if the milk 
aggravates the diarrhea or gives rise to other symptoms, 
it should again be discontinued. When the breast milk 
is of good quality there is rarely any difficulty with these 

In bottle-fed babies every diarrhea, especially during 
warm weather, should be treated as serious, and certain 
precautions be taken. For the first twenty-four hours 
it is a good plan to withhold all food and give plain 
water, as previously suggested. Milk is absolutely con- 
tra-indicated, and must not be given until recovery is 
complete. Under this plan, if the diarrhea is a simple 
one, recovery is rapid. The child's appetite and condi- 
tion must govern the increase in diet. Albumin water, 
rice or barley water, and whey are excellent foods to 
begin with. If these are well borne, malted milk may be 
given, followed, if all goes well, by cows' milk. It is a 
good plan, if the child is old enough to digest it, to mix 
equal parts of barley water and milk together and boil 
them for a few minutes. This is usually well borne, and 
may be the first step in the return to the customary diet. 


111 the infectious forms, so long as the disease is in its 
active stage, milk, since it furnishes an excellent culture 
I ground for the pathogenic bacteria, acts as a poison. In 
li .these severe cases no food sJiould be given fur twenty- 
rfour hours. Plain boiled water or very weak albumin 
water may be given in small doses at frequent intervals. 
Stimulants are frequently ordered at this time. Washing 
out the stomach and giving it absolute rest will fre- 
quently check the vomiting. A common mistake is that 
of putting too many drugs and foods into an irritable, 
nauseated stomach. Absolute rest several hours will 
frequently allay this irritability. 

It the diarrhea continues while the stomach is at rest, 
there is liable to be great thirst. This may in a measure 
be allayed by small bits of ice chipped off with a needle 
and placed in the child's mouth, or the mouth may be 
sponged out with water to which a little lemon juice has 
been added. 

If the amount of fluid extracted from the body renders 
collapse probable, or if the child seems greatly weakened, 
the subcutaneous infusion of normal salt solution is often 
used. This should, of course, be given under aseptic 
precautions. One or more ounces may be given at a 
time, eight ounces being the average amount for twenty- 
four hours. It is astonishing how rapidly this mixture 
is absorbed. 

[When the vomiting ceases and the child becomes more 
comfortable, food will usually be retained. Albumin 
water, Panopeptonc and water, whey, rice water, and 
barley water are the most suitable food.'^. The cereal 
waters agree admirably with some children but not with 
I others. If the child does not take them plain they ^M 

I may be sweetened. ^H 

L J 



The return to milk should be made very gradually. In 
the severe cases cows' milk should be withheld for a week, 
when, if the child's condition permits, it may be tried in 
one small feeding. If it causes no trouble, it may grad- 
ually be added until the usual diet is resumed. The re- 
turn is best made by allowing the articles previously sug- 
gested. Then malted milk, or one of the dry foods that is 
to be mixed with water, may be given, followed by par- 
tially or wholly peptonized milk or the barlej water and 
milk mixture previously described. Plain well-skimmed 
meat broths, such as ve^il broth, may be used. Care must 
be taken to remove all the fat, as this is a frequent source 
of trouble. The milk should not at first contain too 
great a percentage of fat. This bold starvation plan, as 
it is sometimes called, succeeds better than any other. 
Later, however, care must be taken that the periods of 
underfeeding be not too protracted, for while it is desir- 
able to " starve out the diarrhea." the child must not be 
starved to death during the process. A day or two of 
absolute abstinence from food does no harm, as in the 
severe cases food is not retained, or if retained, is not 
assimilated; on the other hand, a reduced diet continued 
for weeks and months, as is not infrequently done, is apt 
to prove disastrous. It is a good plan to keep an accu- 
rate record of all the food taken while the child is on a 
restricted diet. The amounts taken during each twenty- 
four hours may be added together, and from these it 
may readily be seen whether or not the child is getting 
sufficient nourishment. 

Diarrhea in Older Children. — When diarrhea oc- 
curs in older children, the early dietetic treatment is 
similar to that recommended for infants. A.s the child 
recovers a return to the ordinary diet may be made. 


meat, eggs, and broths of various kinds bcins given at 
first, followed by boiled milk and toast or dry bread. 
Vegetables and fruits should be given only after recov- 
ery is complete, and their effect should carefully be 
watched. Cereals may also cause a recurrence of the 
trouble, and should be most thoroughly cooked and 
given in small quantities at first. 

Chronic Intestinal Indigestion. — The diet in this 
disease will always be carefully outlined by the physi- 
cian, and it is of the greatest importance to sec that the 
directions are carried out. The disease is often pro- 
tracted, and requires months or even a year or two of 
careful dieting to relieve the condition. The carbohy- 
drate foods are usually reduced to a minimum and easily 
digestible proteins given. Slight indiscretions in diet fre- 
quently lead to relapses in which all the ground gained 
in several months is lost by a single improper meal. 

Constipation. — This is frequently difficult to over- 
come. Fruit juice given on an empty stomach an hour 
before a milk-feeding is of service, as are olive oil and 
cream. These latter must not be used indiscriminately, 
as they may give rise to other bowel trouble if given in 
too large quantities. The malted foods, such as Mellin's, 
are useful ; mixed with milk or oatmeal gruel well sweet- 
ened they may relieve it. In older children figs and 
prunes stewed together are of value ; oatmeal and bread 
from unbolted flour may be used. A glassful of water 
given on rising is sometimes of assistance. 

Wasting Disease.^The diet is of primary impor- 
tance, but fresh air and exercise and warmth must not 
be overlooked. The infant should in all cases be fed in 
the nurse's arms and never in its crib. The diet is pre- 
scribed by the physician. 


Rickets or Rachitis. — This is due to a diet con- 
taining too little fat and protein and too much carbohy- 
drate. The normal diet should be given, and cream, 
olive oil or cod-liver oil added to the dietary. 



When a man has passed his fiftieth year his diet should 
be guarded. Dietary indiscretions or a too plentiful diet 
will result either in the putting on of flesh, and the con- 
sequent discomforts of obesity, or in the development of 
gout or allied affections. In considering the diet of the 
aged the old dictum, that a man is as old as his arteries, 
applies. Age can not always be counted by years. In 
the aged there is a lessening of all physical activities. 
The old man takes less exercise, has diminished powers 
of digestion, and is less able to absorb the nutriment he 
has digested. His circulation is poor and his bowels are 
constipated. Degenerative processes have taken place 
in his organs, and he is more apt to feel the effects of 
indiscretions in diet. For these reasons the diet should 
be hghter than in his younger years, and the amount of 
food eaten should vary with the needs of the individual. 
The food should be of an easily digestible variety; it 
should be given in smaller quantities at a time and the 
intervals between meals should be shortened. If there 
is a tendency to obesity, food that is liable to be con- 
verted into fat should be given in diminished amounts. 
The proteins should be somewhat lessened from time to 
time. The practice of eating heavy suppers late at night 
and of eating between meals should be discontinued. 
The person should learn what particular articles of food 
disagree with him, and refrain from eating foods that tend 




to cause flatulence. Yeo suggests that in the case of 
cooked fruits a smail quantity (about a teaspoonful to 
the pound of fruit) of sodium bicarbonate be stewed 
with them, to correct the acidity that causes flatulence. 

In the aged, food bears a close relation to sleep. A 
cupful of hot milk, hot toddy, or some hot liquid food 
taken at bedtime will often overcome troublesome sleep- 
lessness. A few .sips of milk or a mild stimulant taken 
during the early morning hours, when the aged are apt 
to awaken, will frequently insure sleep again. 

Food Stlitable for the Aged (Yeo).— Young and 
tender chicken and game and other tender meats ; 
potted chicken, game, and other potted meats ; sweet- 
breads ; white fish, as sole, whiting, smelts, flounder, etc., 
best when boiled; bacon grilled; eggs lightly cooked, 
or beaten up with milk, etc. ; nutritious soups, such as 
chicken or fish purees, beef tea, mutton and chicken 
broths ; milk in all forms when easily digested. When 
it is not well borne, the addition of an equal quantity of 
warm Vichy or of warm water will often prove helpful. 
Beef tea and milk supply the needed mineral substance, 
and the former is an excellent stimulant. 

The following foods are all suitable: Bread-and-milk 
with the crumbs of stale bread and without lumps ; por- 
ridge and oatmeal gruel ; puddings of ground rice, tapi- 
oca, arrowroot, sago, macaroni, with milk or eggs, and 
flavored with spices or served with fruit juice or jelly; 
bread and butter, the bread to be at least a day old ; 
rusk, to be soaked in tea or milk and water. Prepared 
foods, consisting of predigested starches ; at this age the 
digestive ferments are provided scantily by the digestive 
organs, and soluble carbohydrates are valuable for main- 
taining the body heat. All farinaceous foods should be 


subjected to a high temperature for some time during 
the cooking process so as to render the starch granules 
more digestible. 

Vegetable purees of all kinds may be taken in moder- 
ation — e, g,, potatoes, carrots, spinach, and other succu- 
lent vegetables. Potatoes and fresh vegetables are a 
necessity; if omitted a scorbutic state may be engen- 
dered. Stewed celery and stewed Spanish or Portugal 
onions lend variety to the diet. Stewed or baked fruits, 
fruit jellies, and the pulp of perfectly ripe raw fruits in 
small quantity may be taken. 




During: Pregnancy.— The diet should be that to 
which the patient has been accustomed. There is often 
craving for unusual articles of diet, and these cravings 
should not be gratified. Sometimes a diet somewhat 
deficient in carbohydrates and fluids is advised with the 
idea of producing a small child, a thing desirable when 
there are contractions of the pelvis and a difficult labor 
is expected. 

Diet During the Puerperium. — Formerly great 
restrictions were placed on the diet of a recently deliv- 
ered woman, thus accounting, in part, for the loss of 
weight that has been noted. If there is no nausea and 
the patient desires it, a cupful of tea or a glassful of 
warm milk may be given soon after delivery. 

The appetite is generally poor for a few days after 
delivery, but food should be given at regular intervals 
not too widely separated. The first day milk, milk toast, 
or if desired, dry or buttered toast, with coffee, tea, or 
cocoa, according to the taste of the patient, may be 
given. Water may be allowed as desired. On the sec- 
ond and third days simple soups or any of the following 
may be added to the dietary: Meat broths, beef tea, 
soft-boiled or poached eggs, raw or stewed oysters, and 
some simple dessert, such as wine jelly, boiled custard, 



or junket During the next few days chicken, scraped 
beef or mutton in small quantities, baked potato, rice, 
and cereals may be given, and by the end of the week a 
gradual return to the ordinary diet may be made. 

Diet in the Diseases of Pregnancy. — Special 

diets are sometimes ordered the pregnant woman on 
account of diseases connected with her pregnancy. 
Sometimes a milk diet or a diet similar to that used in 
inflammation of the kidneys is used. When salivation 
occurs a milk diet is used. Rectal feeding is used when 
there is uncontrollable vomiting. 


When the patient cannot taku food by the mouth, or 
when it is not desirable to feed him in that way, rectal 
feeding is resorted to. All the various classes of foods 
may be used for this purpose. Proteins are supplied in 
the form of predige.sted meat or egg albumin to which 
salt has been added. Nutrose and peptones arc also 
used. Grajje sugar and starch arc sometimes employed. 
Fat is given in the form of the yolk of egg or cream. 
Milk is much used. Where the patient is to be fed 
by the rectum for any length of time, combinations ofthese 
are used as suggested in the formulas given below. From 
four to seven weeks is the average time by which the 
patient can be kept alive by this method of feeding, but 
a patient has been kept alive for ten months by exclusive 
rectal feeding. 

The success of rectal feeding depends on the proper 
technic. With poor technic the rectum soon becomes 

Procedtire. — The rectum should be cleansed thor- 
oughly by administering a high injection of normal salt 
solution one hour before the enema is to be given. This 
cleansing should be practised at least once a day. and if 
much mucus is present it may be well to precede each 
feeding by a cleansing enema. If the rectum is inflamed 
a solution of boric acid may be used instead of the salt 




I mc 

■ fur 

solution ; or if there is much mucus a solution of sodium 
bicarbonate may be employed, a teaspoonful of either to 
the pint of water beiiifj sufficient. For the first one or two 
cleansing enemata the bowel should be flushed by the 
ordinary method; later, a return-flow catheter maybe 
used; with this several quarts of solution may be used; 
without it one-half to a pint will be sufficient in most cases. 

The temperature of the cleansing enemata should be 
between 95° and 99° F, ; that of the enemata which are 
to be retained between 90° and 95° F. Solutions that 
are too hot or too cold will promptly be rejected. 

The position of the patient is very important. He 
should lie on his side, with the hips well elevated. On 
account of disease this position may be impracticable. 
In this case the foot of the bed may be raised and pillows 
placed under the hips, to make as much elevation as 
possible. A rectal tube or a large catheter should be 
used. This should not, however, be too large ; a tube 
I cm. (about \ inch or less) being the proper size for an 
adult. For children the tube should be proportionately 
smaller. It should be lubricated thoroughly, but glycerin 
should not be used for this purpose. 

In introducing the tube it should be twi.sted slightly, 
which lessens the hability of its becoming impacted in 
the rectal folds. If it is not passed easily a small quan- 
tity of fluid should be allowed to flow in, which will 
serve to balloon out the rectum, after which the tube 
may usually be passed with case for 8 or 10 inches or 
more. The tube should in all cases be introduced as 
h up as possible, as the enema is thus more hkely to 
be retained and absorbed. 

The fluid should be allowed to flow in slowly from 
funnel or a fountain -syringe. In some instances, where 



very small injections are being used, a small hard-rubber 
syringe may be attached to the tube. Care should be 
taken to avoid injecting air with the fluid. The method 
of administering nutrient encmata by means of the old- 
fashioned short hard-rubber nozzle of either a piston or 
a Davidson syringe can not be too strongly condemned. 
In the hands of the unskilful it may cause injury to the 
rectum, and even if used by a trained nurse, only suc- 
ceeds in placing the fluid in the lower part of the rectum, 
where it is liable to be expelled. 

After the injection the patient should lie as quietly as 
possible for at least an hour, and be instructed to try to 
rctaiii the contents of the bowel. A pad of gauze or a 
towel should be pressed over the anus for twenty minutes 
or half an hour, and the mind should, if possible, be 
diverted from the subject. After a few days the bowel 
often acquires a tolerance for the injections and they may 
be retained without difficulty. 

If the rectum is irritable and the fluid rejected, the 
physician may order the nurse to precede the nutrient 
enemata by a small suppository containing opium, or, 
what is better, a small rectal injection of the tincture of 
opium may be given. This may be mixed with a little 
starch water, but the whole should be as small as pos- 
sible. The opium should not be used unless necessary, 
and the dose should be just sufficient to quiet the bowel. 
The opium may be added directly to the enema. 

If there arc hemorrhoids, rectal feeding will be greatly 
interfered with. Before each injection they may be 
painted with a 2 per cent, cocain solution, and between 
the feedings a soothing ointment should be applied. 

The amount to be given at each injection is an im- 
portant factor. As a rule, it should not exceed \ liter 



(^ pint). If this be not well borne the amount may be 
reduced to from 30 to 100 c.c. (1—3 oz.). 

The number of eneniata to be used will depend some- 
what upon the patient's constitution ; as a general rule, 
five, or better six, hours should be allowed to elapse 
between each feeding. 

It is well to remember that packing in the vagina and 
other gynecologic dressings may interfere materially 
with the injection of fluid in the bowel. 

Recipes for Nutrient ISnemata.^ — DujardinBeau- 
metz's Nutiient Enema. — 

1 cupful of miik; 

2 or 3 tablcspoonfuls of liquid or 3 or 3 tea- 
spoonfuls of dry peptone; 

I yolk of egg; 
5 drops of laudanum; 

7 gr. of sodium bicarbonate if the peptone is acid. 
Von Lenbe's Milk-peptone Enema. — 

250 c.c. (8 oz.) milk . . . 170 calories; 
60 gm, (2 oz.) peptone . . 100 

270 calories. 
In place of the peptone a 30 to 50 per cent, solution 
of soluble protein may be used. 
Egg-and-milk Enema. — 

250 c.c. (8 oz.) milk . . . T 70 calorics; 

3 eggs 200 

3 gm. of salt. 

370 calorics. 
Starch-and-milk Enema. — 

60-70 gni. (about 2 oz.) 

starch 250 calories; 

250 c.c. (8 oz.) milk ... 170 

420 calories. 



Sugar-and-milk Enema. — 

60 ^m. (2 oz.) grape sugar 
250 ex. (8 oz.) milk . . 

Pancreas Enema. — 

50-100 gm.{i|-3oz.) pan- 1 

creas substance, average ) 

150-300 gni. (5-8 oz.) meat 1 

30-45 gm. (i-i^oz.)fat . J 

246 calories; 
170 •• 
416 calories, 

300 calories ; 
350 calories; 
650 calories. 


Singer's Enema. — 

125 gm. (4 oz.) milk; 
125 gm. (4 oz.) wine; 

1 or 2 yolks of eggs; 

: teaspoonful of Witte's peptone. 
May be given three, or possibly four, times a day and is 
well borne. 

Biegel's Enema. — 

250 c.c. (8 oz.) milk; 

2 or 3 eggs; 

1 or 2 teaspoonfuls of red wine. 

Riegel docs not use peptone, as he fears that it might 
irritate the rectum and cause diarrhea. 

Ewald's Nutrient Enetaa. — 

2 or 3 eggs ; 

1 tablespoonful of water. 
A small amount of flour is boiled in half a cupful 
of 20 per cent, solution of dextrose and a wineglassful 
of red wine added. The egg solution is stirred in, care 


being taken not to have the solution too hot, lest the 
albumin be coagulated. Entire amount, 250 c.c. (8 oz.). 

A Frequent Army and Hospital Fonnnla. — 

3 to 5 <-'Sgs; 

150 to 250 c.c. (5-8 oz.) 15 to 20 per cent, solu- 
tion of dextrose. 
Add a little starch solution or mucilage to make it 
more viscid, and a few drops of tincture of opium. 

Boas's rormula. — 

230 c.c. (8 oz.) milk; 

3 yolks of eggs; 

A small quantity of salt; 

1 tablespoonful of red wine; 

1 tablespoonful of " Kraftmehl " (Health Flour). 

Jaccoud's Recipe. — 

250 c.c. bouillon; 
120 c.c. wine; 

2 yolks of eggs ; 

4-20 gm. (1-5 dr.) dry peptone. 


Food suppositories are sometimes used, but are usually 
unsatisfactory. Nutrient inunctions, especially with oils, 
are useful in cases of great emaciation. Cocoa butter, 
cocoanut oil, olive or cod-liver oil are the most fre- 
quently used. It is questionable if any of the oil is 
really absorbed, but the rubbing improves the nutrition. 
Subcutaneous feeding by injections of sterile oil is 
sometimes used. Sesame oil is most frequently used. 

Saline Injections and Infusions.— Solutions of 
salt, usually about a teaspoonful to the pint, or .special 



formulas ordered by the physician are used either by 
injecting them into the rectum or by introducing them 
beneath the skin. Such procedures are useful to combat 
shock, and where large quantities of fluid have been 
rapidly lost from the body, as in hemorrhage or diarrhea. 


The nurse should iiuderstand tlii: importance of the 
proper feeding of the patient. Definite directions as to 
how much food, its form, its preparation, and how often 
it is to be given should be written out by the physician. 
In all acute serious conditions, as in pneumonia or in 
typhoid fever, a record of these details should be kept, 
together with the record of the quantity of fluid taken, 
the medicine given, etc. 

There is usually a tendency to err in either extreme — 
that of giving either too much or too little food. Care 
should be taken that the patient's wishes are, wherever 
practicable, carried into effect. The nurse should care- 
fully observe the patient's likes and disHke.s, and also 
note his idiosyncrasies. A tactful, observing nurse is of 
inestimable value, but a careless or stupid one is an ever- 
present source of danger. 

The training of nurses in regard to feeding is often 
faulty. Every nurse should be instructed in the subject 
of practical dietetics, and .should know how much food 
is required by the different types of patients. 

The food should be given at regular intervals. In 
unconscious or semi-conscious patients this is of great 
importance; but it is just as important in the conscious, 
as the appetite usually comes on at certain times, and 
if the meal is not forthcoming may disappear. 

The appetite of the conscious patient and of the con- 


valescent should be fostered, and nothing done that may 
in any way disturb it. Patients vary much in this par- 
ticular, but, as a rule, individuals who are not overfas- 
tidious when they are well become so when weakened 
by disease. 

The sick-room should be orderly, and no dishes, uten- 
sils, or food be allowed to stand about the room either 
before or after using. All food and drink should be 
offered from scrupulously clean glasses or dishes. These 
should be as dainty as possible, and the food must be 
made attractive in appearance ; when the dish permits, it 
may be garnished with a sprig of green. The napkins 
and linen should be spotless. The exterior surface of 
glasses and cups should be wiped diy before they are 
offered to the patient. 

Food that is stale or that has acquired an un- 
pleasant taste from standing in a refrigerator together 
with other things should not be given. A strong ^^'g 
in an egg-nog may be the means of turning a patient 
forever against this form of nourishment. The food 
should be tasted by the nurse, but never, when possi- 
ble, in the patient's presence or with the same spoon. 
If there is anything wrong with a dish, this should be 
discovered and remedied before it is brought to the 

A nurse should always remember the eternal fitness 
of things. Utensils and dishes should be used only for 
the purpose for which they are intended and not as 
makeshifts for other articles. After caring for the patient 
or removing evacuations sufficient time should be allowed 
to elapse before feeding is begun. The patient should 
be made to feel that the utmost cleanliness and care 
have been observed. The hands and face of the patient 



should be wiped with a moist cloth and then dried 
before food is given, and the hps cleansed after the meal 
is completed. 

The position of the patient should be as comfortable 
a one as possible, and one in which he will not tire be- 
fore the meal is endtd. If the patient is weak, the food 
should be given in such form that he may take enough 
of it without inducing fatigue ; otherwise he may become 
tired of masticating and swallowing and take an insuffi- 
cient amount. Patients who can sit up in bed should be 
provided with a bed-tray on which to place the food. 
The legs of the tray should be placed high enough for 
the patient to eat comfortably from it. 

If die patient is helpless, care should be exercised 
in giving food, so that it will not be drawn into the 
lungs during inspiration or coughing. This may be 
avoided by giving the food slowly and by seeing that 
each mouthful is swallowed before another is given. 
These patients may be fed in various ways. The food 
may be given from a spoon, or, what is usually pre- 
ferred, from a drinking-cup with a spout, or by using a 
tube and allowing the patient to take the food from a 
glass. When the patient is taking bread and similar 
solids great care should be exercised not to allow the 
crumbs to fall into the bed. 

In most severe illnesses it is necessary to awaken the 
patient during the night to administer food. This is a 
point that requires special judgment. Often the patient 
is more in need of sleep than of food. If the patient 
does not drop off to sleep very soon after taking food, 
it may be better to wait until he awakens before giving 
it. As a rule, however, in .'severe illness the sleep is 
disturbed for but a few minutes by taking food. A 







cupful of warm milk or similar food may often induce 

The patient's mouth should always be kept clean. If 
dry and parched, it should be rinsed before and after 
taking food. Alkaline mouth-washes may be used; 
boric acid and water also make an efficient wash. If the 
mouth is dry, it should be moistened from time to time, 
and for this purpose a little glycerin water and lemon 
juice will be found useful. If the patient is helpless the 
mouth may be swabbed out with cotton fastened to the 
end of a stout probe or wound about the finger. This 
should be moistened with some antiseptic solution. 

In all cases where the illness is likely to be protracted, 
arrangements should be made to care for and prepare the 
food with as little discomfort to the household as possi- 
ble. For this purpose a diet kitchen may be improvised, 
preferably in a room adjoining the patient's. If the 
patient's means allow, a small sick-room refrigerator 
should be provided, and a tin receptacle for storing foods 
that do not need to be kept on ice. A gas or alcohol 
lamp will serve for heating food. A thermometer, a 
graduate, a funnel, and filter papers are needed, and a 
meat-mincing machine will be found a useful addition. 
Saucepans, a dishpan, and a supply of tea towels should 
also be provided. Boric acid or borax and sodium bicar- 
bonate will help to keep things fresh and clean. In 
cases of infectious and communicable a covered 
boiler for disinfecting all dishes and utensils should be 
added. The dishes should be boiled in water to which 
3 per cent, of sodium bicarbonate has been added, 
and the boiling should be allowed to continue for fully 
twenty minutes after the water has begun to boil. If 
this duty is delegated to someone else and the instruc- 


tions are likely to be carelessly followed out, it is best to 
direct that the dishes he boiled for an hour. 

Feeding: Unconscioas and Refractory Patients. 
— Unconscious patients may oftc-n easily be fed by means 
of a teaspoon, Ivach spoonful should be swallowed 
before a second is given. In the case of comatose 
children, the nourishment maybe poured into the nostril 
instead of into the mouth. The fluid thus given is swal- 
lowed, and any excess returned by the other nostril. If 
any difficulty is experienced in swallowing, it is best to- 
resort either to the stomach or the nasal tube. This is 
usually done by the physician himself With a little 
practice most patients can be fed with the tube more 
easily than in any other way. A mouth-gag should be 
introduced, or a roller bandage may be placed between 
the teeth and held in place by an assistant. In infants 
who have no teeth this precaution is unnecessary, as the 
finger answers the purpose perfectly. The tube, pre- 
viously moistened, is passed into the pharyn.x and rap- 
idly into the stomach. If the tube is not passed rapidly 
through the pharynx, contraction may follow and the 
tube be prevented from entering the esophagus. In 
order to pass the tube into the esophagus, it is neces- 
sar>' to hold it sufficiently well back from the end. 

If nasal feeding is to be used, a nasal tube, or in 
case of infants a catheter, is well oiled and gently passed 
through the nose into the esophagus and then into the 
stomach. Care should be taken not to pass the tube 
into the larynx. This accident can always be avoided 
by waiting a moment before pouring in the food. Either 
stomach or nasal tube should be provided with a 
funnel, and as soon as the tube has been satisfactorily 
introduced, the nourishment — miik, milk and egg, or 



whatever liquid food is desired — may be poured slowly 
into it. 

In order to prevent air from entering in advance of 
the food, a small quantity of the food may be poured 
down the side of the funnel until the tube is full. In 
many cases it may be desirable to wash out the stomach 
before introducing the food. The tube should be with- 
drawn rapidly, so as not to excite vomiting. Food so 
introduced may be retained when it would otherwise be 
vomited. This is true both of infants and adults. 

Forced Feeding^. — In case of refractory patients — 
the insane, the hysteric, and others who refuse to eat — 
forced feeding becomes necessary. In this case enough 
attendants should be present to control the patient. He 
should be held firmly and the nasal or stomach tube may 
be introduced. In order to prevent regurgitation of the 
food, which some patients manage to do quite skilfully 
while it is being introduced, the ribs may be tickled. 
This prevents fixation of the diaphragm, without which 
the food can not be ejected. This should be done only 
when occasion demands. 


In fever the changes taking place in the body are 
increased, while the amount of food assimilated is de- 
creased. For this reason, even if the patient is well fed, 
a certain amount of the body substance is burnt up. If 
the patient is poorly fed or the fever protracted the 
emaciation may be extreme. The appetite is diminished 
or lost entirely, and it may require great tact on the part 
of the nurse to see that the patient takes sufficient food. 
The thirst is increased. 

Foods appropriate for healthy individuals are not, as 



a rule, suited for fever patients, and solid foods usually 
cause vomiting or severe indigestion. In order properly 
to nourish a fever patient, it is necessary that the food be 
easy to take, easy to digest, and easy to assimilate. Any 
food that does not possess these three qualities is not 
suitable for a fever patient. When the disease runs its 
course rapidly, the diet is of no great importance, for 
even if the patient take but little food, the period of com- 
parative fasting is a brief one and any loss is easily made 
up while recovery is in progress. In protracted dis- 
eases, on the other hand, such as typhoid fever, and in 
chronic fevers, the diet is of primary importance. In 
chronic diseases and in those fevers where remissions 
occur, the periods when digestion is comparatively good 
should be taken advantage of and the patient nourished 
and strengthened as much as possible. 

In fevers the mouth requires especial care; the bowels 
likewise should be regulated and constipation avoided. 

Suitable beverages should be given to allay thirst, and 
if the patient is not getting sufficient liquid with his food 
he should be offered water or some other drink every 
three or four hours. This should be done whether or 
not the patient is conscious, for a patient seemingly con- 
scious is often in an apathetic condition. The water is 
required not only to quench thirst, but to aid in the 
elimination of waste products, which, owing to the in- 
creased metabolism, are augmented. The most suitable 
of all drinks is plain water. When this does not agree, 
or to meet special indications, mineral waters are often 
of great use. The natural waters, since they do not con- 
tain such large amounts of carbon dioxid, are best. If 
the artificial waters are used — and this is generally the 
case — they should be allowed partially to effervesce 



. Jest the 

1 the 


before being given to the patient, 
stomach cause unpleasant symptoms. The " Imperial 
Drink" (see Recipes) is very useful and is generally 
taken with a relish. To this may be added the white 
of an egg, beaten up and strained, if the patient is not 
taking much food. Both lemonade and orangeade are 
useful, and the former is particularly valuable. Since the 
hydrochloric acid of the stomach is deficient during 
fevers, water acidulated with hydrochloric or phosphoric 
acid i.s of service, as it increases the powers of digestion. 
Barley water, oatmeal water, toast water, and albumin 
water are all of service, containing, as they do, nourish- 
ment with drink. Albumin water is made by beating 
up the white of a fresh egg, straining it through a cloth, 
and then adding six or eight ounces of water. This 
may be flavored with lemon, orange, sherry, or cognac. 
Wine whey is also of value, and under certain circum- 
stances, as in affections of the bladder, flaxseed tea or 
gum water may be given. Rarely, beer or some other 
beverage is permissible. To those accustomed to taking 
large quantities of beer daily this may be the only means 
of getting the patient to take nourishment. 

The food for fever cases should always be hquid. 
Milk, as it contains various food elements in a suitable 
combination, is the best of this class of foods, and if 
properly administered agrees with most patients and is 
easily digested. It should, as a rule, be diluted, and a 
small quantity of lime water or sodium bicarbonate 
should be added to it. Lime water may be added in 
amounts varying from 5 to 50 per cent., according to 
circumstances. Vichy or Seltzer water, or even ordinary 
water, may be used, and may be flavored if the patient 
prefers. Barley water or oatmeal water may be mixed 


with it, or, what is sometimes of great service, equal 
parts of a cereal water and milk may be boiled together. 
If the mixtures mentioned do not agree the milk should 
be peptonized. Milk should not, however, be pepton- 
ized if the patient can take and digest it without pep- 
tonization. IJuttermilk, kumiss, or whey may also be 
used. Buttermilk, however, contains less nourishment 
than milk; kumiss may not be relished at first, but many 
patients soon learn to like it. Lastly, infants' and in- 
valids' food may be given. Malted milk may be enjoyed 
by the patient, and is useful in those cases in which there 
is diarrhea. 

Eggs may be given raw or in the form of albumin 
water, and an excellent mode of administration, especially 
if the patient requires a stimulant at the same time, is to 
give the time-honored Stokes' brandy-and-egg mixture. 
Given in this form the egg generally agrees. It may be 
well to make up the mixture with one-quarter or one- 
half the amount of brandy. 

Meat juices and broths, for which recipes will be given 
further on, may be used. The meat extracts arc best 
given well diluted. The variety of broth should be 
changed each day, using beef, veal, mutton, and chicken 
in turn, to avoid monotony in the diet. The various 
predigcsted beef preparations and beef juices sold in the 
shops may be used at times, and are often of great 
value, especially when the patient can not retain other 
forms of food. Strained vegetable broths are useful 
occasionally in long-continued fevers, and gelatin prep- 
arations, such as calves'-foot jelly, wine jelly, or fruit 
jelly made with gelatin, may also be employed. Fruit 
juices, especially lemon, orange, and raspberry juices, 
are generally relished. These should be diluted, and are 



best given cold or with cracked ice. Solutions of grape 
sugar alone or drink sweetened with grape sugar are to 
be recommended. Granulated extract of malt dissolved 
in water or milk is relished by some patients. 

The question as to the value of alcohol in fevers is one 
that has been widely discussed. While alcohol has 
doubtless been greatly abused, it is of value both as a 
food and as a stimulant. The quantity to be given and 
the question whether it is to be given or not are to 
be decided only by the physician. Both questions de- 
pend upon circumstances, and the age, condition, habits, 
and tolerance of the patient all play an important part 
in deciding this question. It is usually prescribed in 
small doses at regular intervals, and should, if the 
stronger forms are used, be sufficiently diluted with 




The management of the diet in typhoid fever is one 
of the most important things for a nurse to know. The 
diet to be followed is ordered by the physician, but it 
will depend upon the nurse to see that his orders in this 
respect are carried out in an exact and intelligent man- 
ner. Whether the patient will get sufficient food or not 
frequently depends on the tact and attention of the 

In this disease there is a diminution of the digestive 
and absorptive powers. The digestive juices are less 
active and the functions of the liver more or less dis- 
turbed. In addition there are ulcerations in the intestine, 
which may go on to perforation. During fever the 
metabolism is increased, and unless sufficient food is 
taken and assimilated the body protein will be used up 
and emaciation result. This always occurs to some 
extent in all cases, no matter what the food, and severe 
emaciation may also occui' in well-fed cases from other 
causes. It should be borne in mind that a mild case of 
typhoid fever should be dieted with the same care as a 
severe one. 

Food and drink should be given at regular intervals, 
both by night and by day; the appetite of the patient 
should not be consulted, for these patients are often 
apathetic or have no desire for food. The food should 


be given at intervals of from two to four hours, accord- 
ing to the condition of the patient and the quantity taken 
at a time. Those who are strong and in comparatively 
good condition may take their nourishment at four-hour 
intervals during the night, even if it is given at more 
frequent intervals during the day. 

The question of drink is also of great importance 
in these cases, for in some patients severe thirst is a very 
disagreeable symptom to combat. Pure water, given 
with or without ice, is to be depended upon, but if there 
are no contra-indications this may be varied in many 
ways. The natural spring waters, or if these can not be 
obtained the artificial ones, are often useful. The artificial 
waters contain large quantities of carbon dioxid, and to 
avoid trouble they should always be allowed partially to 
effervesce before they are given to the patient. If there 
is no marked bowel disturbance, fruit juice maybe added 
to the water. Lemonade, orangeade, raspberry juice, and 
raspberry vinegar and water are often welcome changes. 
Weak tea, especially if a little red wine is added to it, is an 
admirable thirst quencher. Cold weak coffee is relished 
by some. Red wine and water, white wines, or even 
sherry or brandy and water may be given to some 
patients, especially if plain water causes unpleasant 
symptoms. When there is irritability of the intestine 
or severe diarrhea, red wine and weak tea are to be 
preferred. Albumin water, since it combines food and 
drink, is most useful. It may be flavored with lemon or 
orange juice, or may be shaken up with a little sherry 
or brandy and ice. (The ^^'g, which should always be 
perfectly fresh, should be beaten and then strained 
through a cloth.) The various mucilaginous drinks 
may be used, but are not generally relished. Gum-arabic 


water, arrowroot water, bread water, barley water, oat- 
meal water, and similar beverages have their place in the 
physician's list of possibilities. 

Uilk. — The food par excellence in this disease is miik. 
There is no one food that meets so many indications. It 
possesses great nutritive value, is easily procured, as a 
rule, and is generally easily administered. It must be 
borne in mind, however, that there are some patients 
with whom milk disagrees, and many who do not like it. 
Milk, however, disagrees less commonly than is gener- 
ally imagined. The amount to be given daily varies 
between one and three quarts, according to the patient. 
There arc not many patients who can take three quarts 
of plain milk, and it is generally a good plan to vary its 
form of administration, and occasionally to substitute 
for it other articles, which will be mentioned further on, 
so that the patient may continue to take milk during the 
entire course of the disease. If milk is given plain, it is 
only a question of time when it will disagree with any 
patient. Children are more apt to take it over long 
periods of time than are adults. At the Garrett Hos- 
pital for Children in Baltimore the authors seldom use 
anj-thing besides milk for typhoid cases, and do not find 
it necessary to make changes in it. For older children 
or adults it should always be modified. When milk 
forms the diet, the mouth requires particular care, as the 
little milk that remains in the mouth often turns the 
patient against the next feeding. 

There are many ways of modifying milk and render- 
ing it more agreeable and more digestible to the patient. 
The simplest method is to add from one to three ounces 
of lime water to each glass of milk, or plain water or a 
mineral water may be used instead. If milk is well borne 


and it is desired to increase the amount of nutriment, 
cream may be added to it. If this causes unpleasant 
symptoms it should be discontinued at once. Butter- 
milk may be given occasionally, but is far inferior in 
nutritive value to plain milk. Kumiss or kefir may be 
used, and while they may not be relished at first, most 
patients learn to enjoy them. A pinch of salt may 
render milk more paiatable to some persons, and the 
addition of a spoonful of brandy may be relished by 
others. The milk may be given cold, be flavored with 
fruit juices, vanilla, or nutmeg, or it may be given in the 
form of ice cream. When milk is not well borne, it is a 
good plan to prepare barley water and add to it an equal 
quantity of milk, boiling them together for a few minutes. 
Plain boiled milk may also be used with benefit. 

Among the disagreeable symptoms to which milk gives 
rise may be mentioned a bad taste in the mouth, which, 
however, is apt to be present in any ; a sense of 
fulness or pressure in the abdomen ; eructation ; or even 
pyrosis. When the milk is not well digested it may 
cause diarrhea, with colicky pains, and the undigested 
curds will be found in the stools. To obviate these 
symptoms the measures previously suggested may be 
tried fsee also Miik Cures). Malted milk may be used, 
or the milk may be mixed with some of the invalid foods, 
or it may be partially or completely peptonized. For 
the last purpose the peptogenic milk powder will be 
found u.seful. 

When milk is found to disagree, other forms of nutri- 
ment must be given. If care is taken to supplement its 
use by other foods from the beginning, the milk will be 
less apt to cause disturbance. 

The carbohydrates are valuable foods in typhoid 

■ St 


and may be used in many different forms. Of these, 
the various grueis are the most easily digested, and may 
be given plain or mixed with milk or bouillon. Oatmeal, 
thoroughly cooked {three hours' boiling at least) and 
strained, is best, but may not agree with the patient. 
Barley water (Robinson's barley flour is an excellent 
preparation for making barley water), arrowroot, sago, 
tapioca, and the prepared foods may all be used. In 
Germany aleuronaut flour is added to bouillon or soups. 

Of the proteins and alhed substances there are a 
number tiiat may be used. Meat is to be forbidden so 
long as fever occurs. Fat must be skimmed from soups, 
broths, and bouillon, as it is apt to disturb the patient's 
digestion. Beef juice made according to any of the 
recipes given in the Appendix may be used, or beef 
juice expressed from very sligiitly broiled beef or 
skimmed dish gravy may be used. This may be served 
in a green glass if the color of the juice is objectionable, 
Bottle bouillon may be employed, as may also the vari- 
ous liquid beef preparations and meat juices now on the 
market. Mosquera Meat Jelly and Valentine's Beef 
Juice are useful but expensive. Beef extracts are more 
stimulating than nutritious. 

Senator recommends gelatinous sub.stances. such as 
gelatin, calves'-foot jelly, bottle bouillon, and the like. 
Oysters may be served with gelatin. The gelatin jellies 
may be flavored with fruit juices or with wine. 

SgrSS should be used sparingly. Egg water, how- 
ever, when properly prepared, rarely causes distress. 
Raw eggs may occasionally be given, or the yolk of an 
egg in bouillon or broth. Eggs and milk together may 
cause indigestion ; but if the patient is in need of a 
stimulant as well as a food, Stokes' brandy-and-egg 



mixture may be used, and in moderate quantities rarely 

Somatose, eucasin, nutrose, and similar preparations 
niiiy be mixed with bouillon or other foods. 

Alcohol holds an important place as a food as well as 
a stimulant in long-continued fevers. The tendency to- 
day is to prescribe it in smaller quantities than formerly, 
and many have abandoned its use altogether. It is, 
nevertheless, a valuable ally in fighting typhoid, and 
should not be discarded. It is not given to children as 
a routine treatment, but even in young patients it is often 
of the greatest service. When given to adults, it is well 
to begin with very small doses and to increase these as 
the patient grows weaker or as the fever continues to 
progress. Too much should not, however, be given ; 
and if the dosage has been too large at first, it can not 
be increased as needed later on. In habitues, alcohol 
will be needed from the outset. 

The form of alcohol to be used is largely dependent 
on the patient's taste. As a rule, good old whisky, 
properly diluted, is best. Old brandy is good, but much 
of the brandy sold is of very inferior qualitj-. The red 
wines are useful, especially when there is diarrhea, and 
the old white wines are excellent if the patient cares for 
them. The brandy-and-egg mixture previously mentioned 
is very useful. 

Care of the Mouth.— This is of primary importance. 
If begun early and persisted in, many undesirable mouth 
conditions can be avoided. If the mouth is in good 
condition the patient can, as a rule, take his food easily; 
if it is not, the greatest difficulty may be experienced. 
After each feeding the mouth should be cleansed care- 
fully, a proceeding that should never be neglected. If 




the patient is strong enough he may rinse the mouth 
with a nwld antiseptic solution. Boric acid solutions to 
which a little glycerin and lemon juice have been added, 
or one of the prepared mouth washes diluted with water, 
may be used; diluted oxygen peroxid is also serviceable. 
If the patient is too weak to do this, the nurse should 
swab the mouth. 

Diet in Digestive Disturbances. — In cases where 
the food is rejected or badly borne it is necessary to. give 
the stomach absolute rest for several hours or i 
Then very small quantities of egg water, barley water 
and lemon juice, or similar preparations may be given. 
Panopeptone and the liquid beef preparations are use- 
ful in this condition, and may be served with cracked 
ice or diluted with water. Weak tea or red wine and 
water in small doses are useful, especially if there is 

For the diarrhea an ice-bag to the abdomen has been 
highly recommended, but is seldom well borne. Instead, 
cloths moistened with cold water may be used. 

For the painful and troublesome accumulation of gas 
in the intestine, either the ice-bag or the cold applications 
may prove beneficial. The authors have obtained excel- 
lent resuhs from the use of turpentine stupes. When 
the meteorism is due to the imperfect digestion of starch, 
the carbohydrates should be reduced or withdrawn ; 
when it is due to milk, the form in which this is given 
should be changed or it should be withdrawn altogether 
for a time. 

Hemorrliage. — When hemorrhage from the bowel 
occurs the intestinal tract should be given absolute rest 
for a number of hours. An ice-bag, cold applications, 
or a cold-water coil should be placed upon the abdomen. 

^^ his 


To relieve the thirat the patient may be allowed to suck 
small bits of ice, or ice-cold water or cold tea may be 
given in spoonful doses. After some hours the patient 
may be given a teaspoonful of cold milk, and tins may 
be repeated every two or three hours. Beyond this, if 
the bleeding is severe, the intestinal tract should be given 
complete rest for twenty-four hours or longer. In addi- 
tion the physician may order opium or morphin. The 
returji to the regular fever diet should be made gradually 
and with caution. 

Perforation.— When perforation of the bowel occurs 
all food should be discontinued. The patients are usually 
operated upon as soon as possible or the patient is given 
anodynes. Following operation, the diet will be that of 
any bowel perforation that has been operated upon. If 
the patient rallies without surgical intervention, or when 
this has been found impracticable, food may be given 
after an interval of twenty-four hours, but only in very 
small quantities at sufficiently wide intervals. It is best 
to begin with teaspoonful doses every three hours, and 
if the food is retained this may gradually be increased. 
Usually food is rejected, and when this is the case the 
stomach should be given complete, for feeding only 
tends to aggravate the condition. 

Convalescence. — The diet during the first weeks of 
convalescence requires as much care and attention as it 
received throughout the febrile period; in fact, since 
these patients often develop a ravenous appetite, born of 
.several weeks' milk diet and fever, even greater care is 
necessary. The patient's wishes should in nowise govern 
his diet, and relatives and friends .should be cautioned 
against giving the patient anything not ordered by the 
physician. Many a relapse and death has been caused 


by the misguided kindness of friends and relatives in this 

When there has been severe bowe! disturbance, the 
patient is to be kept on a liquid diet until the ninth or 
tenth day of the afebrile period. After mild cases, where 
there has been but little bowel disturbance, changes may 
be made in the diet after the fifth or sixth afebrile day. 
In these mild cases the greatest caution is required, as 
they arc often quite as apt to do badly as are the severe 
ones, and the attendants are much more likely to be 
careless in carrying out instructions. 

The first addition to the dietary should be made by 
giving a piece of zwieback over which hot milk or cream 
has been poured. If desired, milk toast, milk and crack- 
ers, or junket may be substituted for this. If this is 
well borne, other articles, such as sofl-boiied eggs, or the 
soft part of oysters, if they are in season and can be 
obtained fresh, may be added from day to day. Thick- 
ened meat broths containing well-boiled rice or vermi- 
celli may be given. Finely scraped raw beef, reduced to 
a pulp in the manner suggested for tuberculosis patients, 
also lends variety. 

Tender meats, vegetables, and breadstuffs in increasing 
quantities may be allowed. Roast chicken, squab, or 
partridge, boiled (white) fish, such as trout ; of the vege- 
tables, spinach, cauliflower tops, asparagus tips, purees 
of peas, carrots, or tender string-beans or artichokes, 
well-cooked rice, and baked potato mashed and served 
with cream or dish gravy; toast, zwieback, crackers, and 
the crust of bread may all be permitted. If the condi- 
tion of the bowel permits, fruit juices may be allowed, 
as well as a baked apple, apple sauce, or junket flavored 
with fruit. Other sick-room delicacies may be ordered 


di- ■ 


at the discretion of the physician. Chops, tender steak, 
and roast beef may generally be given in the third 
afebrile week (very finely divided meat may be allowed 
much earlier), and the diet gradually changed until the 
ordinary diet is resumed. For some time after an attack 
of typhoid fever the patient should be instructed to exer- 
cise care in the selection of his diet, and especially to 
avoid all food, such as green fruit, green corn, crabs, and 
the like, that is likely to cause diarrhea. 

The following menu for the first week of convalescence 
may serve as a guide and may be altered to suit the in- 
dividual case. It may be begun about the fifth or sixth 
afebrile day in mild cases, and about the ninth or tenth 
in severe cases. Milk should form the bulk of the diet 
at this period. 

First Day. — Milk toast, or zwieback covered with hot 
milk or cream, or crackers and milk ; beef juice. 

Second Day, — Chicken broth thickened with rice 
or vermicelli (the rice should be boiled thoroughly); 
soft parts of several oysters, or a very lightly boiled 


Third Day. — Junket; a meat broth thickened with 

well-cooked barley (boiled at least three hours), with 

barley flour, or with stale bread crumbs ; wine jelly ; 

scraped raw beef. 

Fourth Z?^j.— ^Lightly boiled or poached egg ; arrow- 
root, barley gruel, or milk toast ; chicken jelly. 

Fifth Day. — ^Junket; a little well-boiled rice with a 
small amount of finely divided roast chicken, squab, or 
partridge, preferably the white meat; apple sauce if 
bowels permit. 

Sixth Day. — Scraped beef; poached t,%^ ; calves'-foot 
jelly ; baked custard ; piece of toast or zwieback. 


Seventh Day. — A small piece of finely divided broiled 
chop or steak ; baked potato ; baked apple ; well-boiled 
rice and cream for breakfast ; junket for supper. 

Atypical and Complicated Typhoid.— In these 
forms the physician often departs from the usual course 
of diet and orders a diet to meet the special indications. 


The diet is that of all fevers and requires no especial 
precautions. Milk is the main stay, and a quart of milk 
and a pint of broth maybe regarded as a fair daily allow- 
ance. Eggs are better borne than in typhoid and may 
be allowed. Rolls, zwieback, and chopped meat arc 
allowed by some physicians even while there is fever. 
Black coffee is useful if there is stupor. Water should 
be given freely. 


The usual fever diet is used. Owing to the great 
drains on the patient's system when the stage of sup- 
puration is going on, it is desirable that the patient be 
fed up as much as possible during the stage of remission 
of the fever. If there is much pain on swallowing, and 
there often is, the food may be given cold. 

One of the chief dangers of scarlet fever is inflamma- 
tion of the kidneys. The diet should be bland and un- 
irritating to the kidneys. Milk diet should be continued 
for a month, and with this diet nephritis is uncommon. 
The diet need not be strictly milk. The various modifi- 
cations of milk maybe used ; and buttermilk are 


also useful ; oyster or clam broth from which the shell- 
fish have been removed may be given. 

F'tr the thirst, which is generally great, plain or car- 
bonated waters, barley water, orangeade, or lemonade 
may be given freely, A level teaspoonful of cream of 
tartar stirred into a glass of lemonade is a useful diuretic 
drink if albuminuria is present 

Plain vanilla ice cream or plain lemon juice may be 
given in small quantities. Finely shaved ice, also in very 
!>mall cfuantiticsand flavored with a little lemon or orange 
juice, often makes a most grateful addition if angina is 

In all cases the diet should be gradually increased 
from day to day during convalescence. The following 
may serve as a guide to the order in which this increase 
may be made : Milk toast, junket, custard, farina pudding, 
oranges, rite pudding, baked apple, bread and milk, sago 
or tapioca pudding with or without apple, corn-starch 
pudding, boiled custard. 

The return to meat is best made by allowing a small 
quantity of boiled or baked fish, the soft parts of oysters, 
very soft-boiled eggs first, and then the lightest and most 
easily digested meats, chicken, raw or very rare beef in 
minute quantities, and the like. 

During the height of the disease and throughout con- 
valescence c.vtracts should bo avoided, as they con- 
tain large quantities of meat extractives, which are liable 
to irritate the kidneys. 

The diet is that of any fever. No especial precautions 
need be observed. 


Liquid diet should be ijivcn while the fever and swell- 
ing; exist. Acids and astrin';ents should be avoided on 
account of the pain they are liable to cause. 


The diet requires close attention, especially if the case 
is severe. Mild cases should be given a light genei^al 
diet. If the case i.s severe a liquid diet should be given, 
and this should consist largely of milk. The great diffi- 
culty is that the food is liable to be vomited at the close 
of the paroxysms. This may occur so frequently that 
the child has difficulty in retaining sufficient food to 
nourish it. A good plan is to give another meal in place 
of the one which has been vomited, as soon as the child 
is able to take it. 


Egg-nog and milk punch are sometimes useful, although, 
as a rule, stimulants are given alone and not com- 
bined with the food. 

If the patient can not swallow, nutrient cneniata may 
be resorted to ; a nasal or a stomach tube may be em- 
ployed. If the latter mode of feeding is adopted, care 
should be taken to avoid struggles with patients whose 
hearts are weak. 

In all cases, if there is any fever, the food should be 
liquid and should be given in small quantities at regular 
intervals. The most useful of the liquid foods are milk, 
plain, with lime water or a carbonated water, or pepton- 
ized albumin water; .some form of predigested beef, 
liquid beef peptonoids or panopeptone ; soups and 
gruels, and the various prepared foods, of which malted 
milk, Eskay's or Mellin's foods are examples. 




OccasionalJy semi-solids are swallowed with greater 
ease than liquids ; in this case any of the foods just men- 
tioned may be thickened with well-cooked cereals or 
gelatin, or custards or junket may be given. Ice cream, 
if plain, may be allowed in moderate quantities. 

Intubation, — After intubation has been done there 
may or may not be some difficulty in swallowing. As 
a rule, when the child swallows for the first time 
there may be a slight cough or some hesitation ; in the 
majority of cases, however, this disappears as the appre- 
hension of the child is allayed. There may be a little 
difficulty for the first day, but this passes off gradually 
as the muscles become accustomed to work under the 
new conditions. 

If the child is old enough he should be instructed to 
take the food as rapidly as possible and then to cough 
afterward, instead of after each act of deglutition, as he 
is apt to do. In some children there may be a slight 
regurgitation through the nose. Taken all in all, the 
difficulty experienced in feeding these cases is small 
compared to the enormous benefit the child derives from 
the operation. 

If there is difficulty in swallowing liquids, solid or 
semi-solid food may be given instead. The child may 
be placed with his head lower than his body. In this 
position swallowing becomes easy. The child may also 
lie across the nurse's lap, with his head thrown well back 
and down. It should always be remembered that food 
may be refused because of nausea, or because the child 
has no desire to take anything, as well as owing to any 
actual difficulty in swallowing. 

The diet should be the same as in non-operative, 
and if semi-solids or solids are required, soft-boiled eggs. 



milk toast, custards, bread and milk, oatmeal porridge, 
and similar foods may be given. 

If swallowing becomes impossible, an event that oc- 
curs very rarely, the child may be fed with the stomach 
or nasal tube or by means of nutrient enemata. 

No especial dietetic rules are necessary for feeding 
tracheotomy cases. 

Postdiphtheric Paralysis.— In paralysis of the 
muscles of deglutition which may occur after diphtheria, 
most of the food may return through the nose ; or if the 
muscles of the tongue as well as the soft palate are in- 
voved, deglutition becomes impossible. When this occurs, 
the child must be fed with the stomach or nasal tube or 
by the rectum. 


The diet in this disease is still a matter of dispute. 
During the acute stage it is best to give milk or a milk 
and farinaceous diet. Buttermilk, gruels, and the like 
are useful. A gradual return is made to the customary 


Food is usually withheld duHng the first stage of the 
disease, as it is almost certain to be vomited if given and 
only aggravates the condition. Stimulants and saline 
solution and even food may be given by rectal injec- 
tions. Milk and lime water or albumin water are given 
during the third day and thf diet gradually increased as 
the physician sees fit. If the patient grows worse every- 
thing is vomited, 


Liquid nourishment is given, when possible, between 
the teeth ; if the teeth fit too closely together it is some- 
times customary to remove one. A nasal-tube can be 


used in some cases and a rectal tube in others. When 
the disease is so severe that the slightest movements 
about the patient produce convulsions, feeding becomes 
impossible except while he is under the influence of an 

Only those who have seen this terrible disease appre- 
ciate the difficulties in feeding these patients. Liquid 
nounshment may be given so long as the patient can 
swallow if he desires food. Even the slightest move- 
ments near the patient produce spasms, and, as the 
result is uniformly fatal, it is not necessary to add to the 
patient's sufferings by trying to feed him. 


Diet in tuberculo.sis is of primary importance. We 
shall consider only pulmonary tuberculosis, for the same 
rules apply to all forms. 

The weight of the patient is a fair guide as to the state 
of his nutrition. To maintain this rest is essential, and 
in addition to the full night's rest the patient should lie 
down at least half an hour after meals. 

The food is to be chosen from the articles mentioned 
below, although other things may be given. The food 
should be made as attractive as possible. Detweiler was 
fond of saying, " My kitchen is my pharmacy." 

Milk. — This is one of the most important articles of 
diet for the tuberculous patient. Unless some special 
reason exists, milk should always form a part of the diet. 
It may be taken with the meals or be given between the 
intervals of feeding. It is of the utmost importance 
that the milk be sipped slowly and not swallowed quickly 
in large quantities. The milk may be taken plain or 


may be modified in various ways. Lime water may be 
added, with or without the addition of cream ; carbon- 
ated water may be mixed with it or the milk may be 
peptonized. Buttermilk or may be taken if 

Eggs, when they can be taken in sufficient quanti- 
ties, are also of the greatest value. In certain cases, 
however, they may not be well borne. If the entire egg 
can not be taken, the whites alone may be given. Egg 
albumin often renders most efficient service in helping 
to nourish these patients. The whites of from six to 
twenty-four eggs beaten up lightly and strained through 
a cloth may be taken daily. A very small pinch of salt 
and a little lemon juice or other flavoring substance may 
be added. Given in this way a large number of eggs can 
easily be taken and are almost invariably well borne. If 
the patient can digest the eggs entire they may be very 
lightly boiled, or, as a change, they may be made into a 
light omelet or poached. Hard-boiled and fried eggs 
should not be eaten. 

Meat. — Meat of all kinds, if properly prepared, may 
be eaten ; but " high " game, highly seasoned dishes, 
and twice-cooked meats should be avoided. Beef and 
mutton are the most suitable varieties. Raw meats, 
especially raw beef, is given in the form of a finely 
divided pulp. This is prepared by scraping the meat 
with a knife, which will result in a mass of shredded 
meat fiber. This is placed in a mortar and pounded and 
rubbed with a pestle until quite smooth. It is then 
pressed gently through a sieve to remove any larger 
particles. This raw meat pulp is very easily digested 
and highly nutritious. It may be given in various 
as spread on sandwiches or given in milk or in 

ways, ^H 



bouillon. It may be mixed with purees of various kinds 
or with vegetables, or, in case of children, with small 
quantities of preserves. It may be rolled into balls and, 
so, easily swallowed ; or it may be served with an egg, 
with anchovies, or with pickled herring. 

Meat juice is also of great value. This may be pre- 
pared according to any of the recipes given in the Appen- 
dix, or the juice may be expressed from beef by means 
of a meat press. Good round-steak should be very 
slightly broiled, cut into .small cubes, and the juice 
pressed out. With a good press about eight ounces of 
juice can be extracted from a pound of meat. This 
should be .seasoned, and heated by placing the vessel 
containing it in warm water. Care should be taken not 
to heat it too thoroughly, or the albumin will coagulate 
and the juice be .spoiled. Freshly prepared beef juice is 
always preferable, but when this can not be obtained, 
liquid beef peptonoids, predigested beef, or Mosquera 
Beef Meal may be employed. 

For patients who can not or will not take raw beef, 
very rare steak, roast beef, or beef soup should be sub- 

Pish. — Fresh fish, boiled, broiled, or baked, may be 
allowed. Both oysters and clams from which the hard 
portion has been removed may be eaten, preferably raw, 
but they may also be given stewed, roasted, or broiled. 

Cereals. — Where these can be digested they are of 
value. In the early stages of the disease they serve not 
only as nutriment, but also aid in regulating the bowels, 
and are usually easily digested. If there is constipation 
they are of especial value. Oatmeal, wheaten grits, 
commeal mush, and rice and milk are the most suitable 



Vegetables. — Any of tfie easily digested vegetables 
may be allowed. They should be steamed or cooked 
with as little water as possible, to avoid dissolving out 
the salts, which, togclher with much nutriment, arc 
thrown away with the water. 

Wheat. — Wheat or rye bread or a mixture of both 
may be used. Zwieback is of great value. All hot 
breads, pastry, and cakes should be avoided. 

Fruit. — All fresh and, preferably, ripe fruit may be 
allowed in moderation. It should be taken the first 
thing in the morning or as a dessert. Oranges and baked 
apples are well borne and useful, and grapes, peaches, 
pears, and other fruit in season may be allowed. 

Fats. — In tuberculosis, when fats and oils can be 
taken and absorbed, the prognosis is always much better 
than when these can not be tolerated. While they arc 
of the greatest value in treatment, care should be taken 
not to disturb the patient's digestion by forcing more 
fatty foods into the dietary than the stomach will toler- 
ate. Most patients, however, soon acquire a dislike for 
fats of all kinds. They are best given in the form of 
cream and butter; the yolks of eggs, crisp fat bacon, 
and olive oil are also useful. Cod-liver oil is really as 
much a food as a medicine. Kither the plain oil or an 
emulsion may be used, and the doses should be small 
to begin with and gradually be increased. A common 
mistake is to administer the oil in excessive quantities. 
Only perfectly sweet fresh oil is to be used, as rancid or 
stale oil may disturb the digestion. Its use should be 
discontinued from time to time. Children bear oil better 
than adults. If there is a tendency to diarrhea, fats and 
oils must be used with caution. 

Alcohol. — Concerning the use of alcohol in the treat- 


ment of tuberculosis, it may be said that, except in the 
last stages of the disease, it is best avoided. 

Patients who are gaining in weight or who arc in good 
condition are better off without alcohol. Those who are 
going down hill may often take light wine, beer, or well- 
diluted spirits with advantage. Of the last, well -matured is the best. 

Patients with high fever who are in an exhausted con- 
dition may be given alcohol freely, following the same 
rules as were laid down in the general consideration of 
fevers. In these cases alcohol is given as a food, and is, as 
a rule, well borne. In these advanced cases pure whisky 
well diluted is perhaps the best form of alcoholic stimulant, 
but the patient's taste may be consulted in this respect. 

Other Beverages. — The usual beverages may be 
given in moderation. In chronic tuberculosis cocoa may 
be taken night and nmniing with good effect. Tea or 
coffee may be allowed in small quantities unless they 
produce unfavorable .symptoms. Milk and milk punch, 
buttermilk, lemonade, or orangeade may be used, and 
malt extracts are often of benefit. 

Number of Meals. — Food may be given from three 
to six times daily. On rising milk may be taken, or if 
desired a cup of bouillon in.stead. This may be followed 
by breakfast, and about the middle of the morning a 
glassful of milk, egg albumin, beef juice, or broth may 
be given with a cracker or a piece of toast. 

A midday dinner should be the rule, and during the 
middle of the afternoon a light lunch of .scraped beef, 
milk, or some similar food may be given. 

Supper may be taken at a convenient evening hour, 
and before going to bed a glassful of milk may be drunk. 
If desired or if deemed necessary a small amount of 




liquid nourishment may be taken during the night if the 
patient awakens. As a rule, however, it is well to give the 
stomach a full night's rest. In severe cases, where only 
small quantities of liquid or semi-solid food are taken, the 
intervals should be shortened to every two or three hours. 

Feeding Advanced Cases. — In advanced cases 
patients may generally be permitted to select their diet. 
These patients can often eat hearty meals with a relish 
and apparently digest them without difficulty. Asa rule, 
they must be light, liquid or semi-solid. The same prin- 
ciples may be applied here as in feeding fever cases, with 
the exception that the patient's desires should, so far as 
possible, be gratified. 

Gastric Irritability. — This is very troublesome in 
some cases. The patient should be instructed not to 
swallow his sputum. If the attack is severe, easily 
digested liquid food should be given. Peptonized milk, 
kumiss, and the predigested beef preparations are of 
value. If there be continued irritability and the patient 
becomes unable to retain his meals, marked relief is fre- 
quently afforded by feeding with a stomach tube. 

Fever. — Tuberculosis patients with fever should be 
fed much according to the general rules given for fevers 
in general. If the digestion is not disturbed and the 
appetite is good easily digested solid food may be allowed. 
If the solid food does not agree the patient should be 
placed upon a liquid diet. 

Forced Feeding ( Suralimentation ). — Debove 
discovered that food introduced by means of a stomach 
tube was often retained when it would otherwise be re- 
jected. This method is used in gastric irritability and 

so where the patient is unable to take sufficient food 
owing to loss of appetite and disgust for food. 


In diseases of the stomach the selection of a proper 
diet is often of more importance than the choice of drugs. 
No absolute dietetic regulations can be formulated in 
this class of diseases, but it is important to regulate the 
food in conformity with the particular disease with which 
the patient is affected, and also to consider the individual 
tastes and peculiarities of the patient ; even in the regu- 
lation of a diet in any special disease of the stomach, 
changes are often rendered necessary; these must be 
made gradually and according to the patient's power to 
digest the food. 

Food is said to be easily digestible when it produces 
no gastro-intestinal discomfort, is passed from the stomach 
into the intestine at a normal rate of speed, and is easily 
absorbed. Under normal conditions the digestibility of 
foods is easily ascertained, for the functions of the stom- 
ach being normal, the effect of the food upon the func- 
tions can readily be determined; in the various gastric 
disturbances, however, this problem is more difficult. In 
determining the diet for a special gastric disturbance two 
points must be borne in mind : first, the power to increase 
the nutrition of the patient ; and secondly, the necessity 
of giving food in a digestible form, so as to lessen the 
work of the stomach. Leube has devised a scale of the 
various articles of food, given in the order of their digest- 



ibility. This scale forms the basis of the well-known 
Leube " ulcer diet." 

I/eube'S Diet Scale. — Diet /.—If the digestion is 
very much reduced the following articles of food are 
most easily digestible : bouillon, meat solution, milk, raw 
or soft-boiled eggs. 

Diet IL — Somewhat less digestible than Diet I. are the 
following articles of food: boiled calf*s brain, boiled 
thymus, boiled chicken and pigeon. The different forms 
of meat are enumerated in the order of their digestibility. 
Gruels, and in the evening milk mushes made with tapioca 
and white of egg, may also be placed in this list. The 
majority of patients can digest boiled calves* feet in addi- 
tion to the various meat foods already enumerated. 

Diet III, — If Diet II. is well borne, Diet III. may be 
given. This consists in adding cooked or raw beef to 
Diet II. Leube gives the following method of preparing 
beefsteak, and believes that beef cooked in this way is 
very easily digested : The meat should be kept for some 
time and is then scraped with a dull spoon ; in this way 
a pulp is obtained, consisting only of the delicate parts 
of the muscle, and not containing any of the tough, hard, 
and sinewy portion. This pulp is roasted in fresh butter. 
Raw ham is also to be recommended. In addition to 
meat a small quantity of mashed potatoes may be given, 
some stale wheat bread, and small amounts of coffee or 
tea with milk (cautiously). 

Diet IV. — This list is so arranged that if the patient 
can digest the articles of food mentioned under this head 
for some time he can then begin with his usually accus- 
tomed diet : Roast chicken, roast pigeon, venison, par- 
tridge, roast beef, medium to raw (particularly cold) ; veal 
(from the leg), pickerel; boiled shad (trout, even when 



young, is very difficult to digest), macaroni, bouilli 
with rice. Small quantities of wine may be taken 
to two hours before eating; gravies are contra-indi- 
cated. Young and finely chopped spinach is allowable; 
other vegetables, such as asparagus, may be tried cau- 
tiously, although Lcubc considers this a risky procedure. 
After this fourth diet the patients are allowed to take a 
more liberal diet, but the increase should be gradual. 
They should refrain from eating vegetables, salads, pre- 
serves, and fruits for some time ; and when they are re- 
sumed a baked apple is the first of these articles to be 

Penzoldt has devised the following table giving the 
digestibility of food. He experimented on normal cases, 
achieving his results by means of the stomach tube, by 
determining the progress of digestion and the exact time 
at which the stomach was entirely empty after eating a 
certain quantity of a special food. The table shows the 
period of time it takes a given quantity of food to leave 
the stomach : 

3uillon ^H 

i^n one "^H 

On, to 

too hoiin : 

rhrt! to four hours .- 

100-200 gin. pure wnler. 

230 gm. youDg chicken, boiled. 

220 gm 

carbonnted water. 

230 gm. jartridge, boiled. 

200 gm 

220-260 gm, pigeon, boileJ, 

300 gin 

coffee, alone. 

'95 gm- pigeon, f"*''- 

200 gni 

cocoa, alone. 

250 gm. beef, raw, boiled, lean. 

200 gm 


250 gm. calves' feet, boiled. 


licht wines. 

ibogm. ham, iKiiled, 

100-200 gm 

boiled milk. 

160 gm, ham, raw. 

meal broth, alone. 

loogm. veal, warn, and cold. 

100 gm 



100 gm, beefsteak, broiled, cold 

Txno lo three hours : 

or warm. 

20O gro. coffee willi crf«m. 

100 gin. beefsteak, raw, scraped. 


cocon witli niilk. 

100 gni. tenderloin. 

200 gm 

Malaga wine. 

200 gra. Rhine salmon, boiled. 


■'Ofner'' wine. 

75 gm. caviare, sailed. 


200 gm, sardines in vinegar, 



kippered herring. 




Fenzoldl digestibility table {ioiiliii 


Two to three hours .■ 

Thrif Is four h„u's : 

300-500 gin. boiled milk. 

150 gm. blackbrcad. 

100 gin. eres, raw and scrambled. 

Ijogm. barley bread. 


150 gm- wheat bread. 

100 gm. beef sausage, raw. 

00-150 gm. Albert biscuits. 

2JO gm. calves' brains, lioiled. 

150 gm. potato, as vegetable. 

250 gm. calves' thymus, boiled. 

150 gm. rice, boiled. 

72 gm. oysters, raw. 

150 gm, kohlrabi, boiled. 

aoo gm. carp, boiled. 

150 gm. carrots, boiled. 

JOO gm. pike, boiled. 

15a gm. spinach, boiled. 

3oa gm. shellfish, boiled. 

150 gm. cucumber salad. 

zoo gm. cod, boiled. 

150 gm. radishes, raw. 

150 gm. apples. 

150 gm. asparagus, boiled. 

Four to five hours. 

150 gm. potatoes, boiled in salt 

210 gm. pigeon, broiled. 

250 gm. fillet of beef, broiled. 

150 gm. mashed potatoes. 

250 gm. beefsteak, broiled. 

150 gm. stewed cherries. 

250 gm. beef tongue, smoked. 

ISOgm, raw cherries. 

100 gm. smoked beef in slices. 

yogm, white bread, oldorfresh, 

250 gm. hare, broiled. 

dry or with tea. 

250 gm. partridge, broileiJ. 

7oem. pretzek 

250 gm. goose, broiled. 

70 gm. iwieback, fresh or stale. 

280 gm. duck, broiled. 

dry or with lea. 

200 gm. herring, salted. 

50 gm. .Mbert biscuits. 

150 gm. lentils, mashed. 

200 gm, peas as purf e. 

150 gm. string-beani!. 

Penzoldt has also constructed a serie.s of four diet lists ^H 

based on the length of time at which various foods leave ^| 

the stomach, depending upor 

their mode of preparation ^H 

and on other qualities of the food. They agree in the ^| 

main with Leube's diet lists, 

but are more complete and ^| 



These diet Hsts are utilized 

in the treatment of diseases ^| 

of the stomach requiring a gradual change from the most ^| 

digestible form of liquid food to solid foods more difficult ^ 

of digestion. Ulcer of the stomach may be cited as an 

example. The first list is 

followed for ten days ; the 

second, for the succeeding ten days ; the third, for the ^M 




Beginning with broth, milk, and eggs in the first days, 
the patient is given such food as roast beef, fish, and 
asparagus at the end of one month. 

Diei I, (abotU Ten Days), 


Food or drink. 

quantity to 

be taken at 

one time 

Method of 

Special require- 

How to be eaten. 

Meat broth. 

350 gm. 

From beef. 

Without fat, or 
not salted. 


Cows' milk. 

350 gm. 

Well boiled or 

Entire milk (or 

\{ desired, with a 


lime water, J^; 
milk, %). 

little tea. 


z or 3 

Very soft, just 


If taken raw. 
should be stirred 

heated or raw. 

into the warm. 

not boiling, meat 


Meat solution 

30-40 gm. 

Should have only 

In teaspoonful 


a slight meat- 

doses, stirred in 


broth odor. 

meat 'broth. 

Cakes (Albert 


Without sugar. 



J^ Uter. 

Ordinary water 
or natural car- 
bonated water 
with a small 
percentage of 
COa (Seltzer). 

Not too cold. 



Het IL {about T 

fn Days). 

Calves' brains. 

100 gm. 


Freed from all Best taken in meat 
membranes. broth . 

Thymus (calQ. 

100 gm. 


Freed from all Best taken in meat 
membranes. broth. 




Only if young, Best taken in meat 
without skin. ' broth, 
tendons, and 

the like. 


As large as 


As above (no fat- Best taken in meat 

a pigeon. 

tened chicken). broth. 

Raw beef. 

100 gm. 

Chopped fine or 

From the tender- To be eaten with 

scraped, with a 



little salt. 

Raw beef sau- 

100 gm. 

Without any ad- 

Smoked a little. 

To be eaten with 




1 apioca. 

30 gm. 

Boiled with milk 
to make gruel. 



Diet III. {about Eight Days). 

Food or drink. 





Milk bread, 
zwieback or 




quantity to 

be taken at 

one time. 

zoo gm. 

xoo gm. 

50 gm. 

50 gm. 

50 gm. 

Method of 

Special require- 

Broiled with fresh 

Broiled with fresh 

With fresh butter 
half-rare (Eng- 

Raw, scraped fine. 

Crisped, baked. 

{a] Mashed, {b) 
boiled in salt 
water and 

As a vegetable, 
boiled in salt 

Only young bird, 
skin, etc. 

Only young bird, 
skin, etc. 

From the tender- 
loin; well beaten. 

Smoked a little, 
without the 

Stale (so-called 
rolls, etc.). 

The potatoes 
should be mealy 
and crumble on 

Use only the 

How to be eaten. 

Without gravy. 
Without gravy. 
Without gravy. 

With white bread. 

To be carefully 
masticated and 
well salivated. 

Diet IV. {about Eight to Fourteen Days). 


100 gm. 




Roasted without 

Roast beef. 

100 gm. 

Medium to rare. 

Fillet of beef. 

loo gm. 

Medium to rare. 


Pike 1 

Shad 1 



100 gm.-< 


Boiled in salt 
water without 
any additions. 


50 g»n. 



50 gn»- 
50 gm. 

Mashed, pushed 
through a sieve. 

Omelet (souffi6) 


With a little fresh 

butter and salt. 

With about 20 gm. 

Fruit sauce. 

50 gm. 

of sugar. 
From fresh boiled 
fruit, to be 
strained through 

Red wine. 

zoo gm. 

•"a sieve 

Light, pure Bor- 

From the back, 
should hang for 
a time. 

Young birds, with- 
out skins, ten- 
dons, legs, etc. 
should hang for 
a time. 

From good, fatted 
cattle; beaten. 

From good, fatted 
cattle; beaten. 

Back or leg. 

All fish bones 
should be care- 
fully removed. 

Slightly salt, Rus- 
sian caviare. 

Soft, without any 
of the hard 

Must have risen 

Free from all ker- 
nels and peel. 

Or some corre- 
sponding kind 
of red wine. 

Warm or cold. 
Warm or cold. 
Warm or cold. 


In the fish gravy. 

With a Uttle melt- 
ed butter. 

To be eaten at 

Slightly warm. 


These tables of Penzoldt are valuable as a basis for 
the selection of food in gastric disturbances. In these 
cases it is important that the food be quickly dissolved 
in the gastric secretion, that it be readily absorbed, that 
it be neither fermented nor decomposed while bein^ 
digested or absorbed, and that the entire process be in- 
attended with discomfort. It must be borne in mind that 
the digestibihty of food varies widely with the individual 
taste, for no matter how digestible a food may be, if it is 
unpalatable it will not be digested properly. In general 
it may be said ; First, that in acute conditions the food 
should be of such a character that the stomach should 
be spared as much work as possible ; second, in chronic 
disturbances it is important to supply sufficient quantities 
of nourishment in an easily digestible form, so as to 
maintain the body weight so far as possible. In deter- 
mining the quantity of food that is necessary during 
twenty-four hours, the amount is estimated in calories of 
heat. As is we!! known, a human being at rest requires 
35 calories per kilo of weight; whereas while he is per- 
forming light work he requires 40 calories. In order, 
therefore, to determine the exact amount of nourishment, 
it is only necessary to know the weight of the individual. 
Inasmuch as the proteins can be replaced in a measure 
by the carbohydrates and fats, an intercliange of any of 
these three food elements can be made according to the 
patient's condition. When the weight of the person is 
known, it is an easy matter to determine whether the 
amount of nourishment given is sufficient to maintain the 
body weight. 

It is well also to weigh every patient suffering with 
a stomach disorder when treatment is first inaugu- 
rated, and to repeat this from time to time, in order 



to determine whether the patient is gaining or losing 

The diet must be considered from the standpoint of 
the gastric secretion ; there may exist, on the one hand, 
the condition of oversecretion of acid ; on tiie other, 
lessened secredon or absence of acid. 

In cases of oversecretion an abundant protein diet is 
indicated, inasmuch as the e.-^cess of hydrochloric acid is 
neutrah^ed by this class of foods. Ordinarily, the pro- 
teins that are best adapted for patients suffering from 
oversecretion of acid are the red meats and eggs, whereas 
the carbohydrates must be given in the most easily 
digestible form. 

In cases in which there is a diminution of the gastric 
secretion the protein foods are digested with difficulty, 
whereas the carbohydrates are more easily digested. In 
this condition, therefore, only very tender meats, prefer- 
ably scraped, are to be given ; whereas such easily 
digestible vegetables as spinach, asparagus, mashed pota- 
toes, and farinaceous foods may be eaten in quite large 
quantities. In both conditions of increased and dimin- 
ished secretion of acid a reasonable amount of fat must 
be eaten, preferably in the form of good butter. 

The diet in muscular disturbances of the stomach 
depends greatly upon whether an excess or a deficiency 
of gastric juice is secreted ; if there is an increase, an 
excess in protein food gives the best results; if, on the 
other hand, there is a diminution of this secretion, pro- 
tein food must be given the patient in the most easily 
digestible form. The carbohydrates and the lighter vege- 
tables may be given in somewhat larger proportion. In 
both conditions the ingestion of fluids should be reduced 
so far as possible. 


Normally, the appetite is a fair indication of the num- 
ber of calories of heat that may be required ; in condi- 
tions of gastric disorder, however, this is not the case ; 
these patients lose their appetite, and consequently often 
take insufficient nutrition. In those instances in which 
the gastric disorder is somewhat protracted and accom- 
panied by great loss of weight and in which the patient 
takes insufficient nourishment, it need only be borne 
in mind that such a patient, resting quietly in bed, re- 
quires only about one-sixth of the number of calories 
necessary for a patient who is not resting. This plan 
may therefore be used with advantage in the treat- 
ment of many patients suffering from disorders of the 

I^iqnid Foods in Gastric Disorders. — In these 
cases, in which it is necessary to spare the stomach as 
much work a^^ possible, milk is the food that is usually 
most easily borne. In order to supply a sufficient num- 
ber of calories it must be taken in large quantities, fre- 
quently diluted with lime water or barley water in order 
to add to its digestibility, or flavored with coffee, tea, or 
cocoa to lend variety and add to its palatability. In 
these cases in which milk is not well borne, buttermilk, 
whey, kumiss, and kefir may serve as substitutes. Among 
the other forms of fluids that may be given are broths 
(chicken, beef, mutton), bouillon, beef tea, and meat 
juice. Of these, meat juice is most nutritious, 

Qelatinous Formfi of Food. — Gelatinous articles of food, 
as gelatin, calves' feet, etc., are easily digested and readily 

HeatB. — The digestibility of meat can be increased by 
chopping, beating, grinding, scraping, etc. 

Eggs. — The digestibility of eggs depends upon their 

k fresh 1 


mode of preparation ; raw and soft-boiled eggs are usually 
the most easily digestible forms. 

Fish. — In regard to fish, those containing but little fat 
are to be recommended for patients suffering from gastric 
disturbances, such as shellfish, pike, trout, carp, and 

Carbohydrates. — The number of vegetables from which 
selection may be made is large. The secretion from the 
mouth and intestines play an important role in the 
digestion of these substances. They should be masti- 
cated thoroughly. In those cases in which there is 
danger of fermentation they should be given with caution. 
The best form in which to give amylaceous food is in the 
form of zwieback, toast, stale wheat bread, tapioca flour, 
oatmeal, etc. 

Legiuninoua foods contain a considerable amount of 
protein, much of which, however, is not absorbed. They 
are apt to give rise to considei-able fermentation. Pota- 
toes are best given mashed or baked. Cabbage contains 
much cellulose and should be omitted from the diet of 
all patients suffering from stomach disorders. 

rmita are of slight nutritive value, but give a relish to 
other foods and increase intestinal peristalsis. 

Fat is to be recommended because of its tendency to 
increase the weight of the patient, and also because of 
its high caloric value. Some observers claim, however, 
that it acts as an irritant to the stomach. It is true Chat 
many patients find that fat meat, greasy gravies, etc., give 
rise to indigestion, and often to nausea and vomiting. 
Much depends, however, on the mode of preparation. A 
considerable amount of fat may be given in the forms of 
fresh butter spread on wheat bread or toast. Certain 
forms of chocolate contain quite a large percentage of 

1 86 


fat, and on this account are very nutritious. Of these, 
Mehring's Vigor Chocolate is to be especially recom- 
mended. Olive oil has recently been recommended in 
the treatment of certain ga.stric disorders. 

Special Factors Beaiiog on the Diet in Pa- 
tients Siifferin^f from Gastric Disturbances. — [. 
Von Noorden demonstrated the fact that the intestine 
will vicariously perform the work of the stomach in con- 
ditions in which the secretion of the latter is lost. The 
point to be borne in mind is that even in cases in which 
the secretion of the stomach is lost entirely, the intestine 
may assume this function of the stomach. 

2. In those cases in which it is necessary to spare the 
stomach, as when food can not be digested or is vomited, 
either predigested foods may be utilized or foods may be 
administered through channels other than the stomach. 
Among the artificial predigested preparations are the 
albumoses and peptones, Denayer's Albumose-peptone, 
Somatose, Nutrose, and Mosqiiera Beef Meal. For the 
various methods of feeding, the reader is referred to the 
sections on Rectal Feeding, Subcutaneous Feeding, etc, 

3. The following rules for eating should be carried 

{d) Food should be thoroughly masticated ; this is 
especially important in those cases in which there are 
marked gastric disturbances. 

(b) The meals should be taken at regular intervals and 
in moderate quantities, according to the nature of the 
gastric disease. 

(r) The temperature of the food is also an important 
factor in the treatment of gastric disturbances ; as Uffel- 
mann has pointed out, the food should be taken at a tem- 
perature between 98° and 100° K. The ingestion of very 


hot food is believed to be a frequent cause of ulcer of the 
stomach. On the other hand, Wegele attributes the dys- 
pepsia of many Americans to the taking of ice-cold water 
and other drinks. 

{d) The question of rest or exercise after eating is 
one that is of considerable importance to those suffer- 
ing from gastric disturbances. It is generally admitted 
that violent exercise should not l>e indulged in after 

From the authors' observations, it appears that in con- 
ditions of gastric disturbances accompanied by increased 
or decreased acidity and in muscular disturbances of the 
stomach, the gastric digestion is improved during rest, but 
impaired by sleep, after meals. 

Special Cures in the Treatment of the Dis- 
eases of the Stomach.— Among the special forms 
of treatment recommended in gastric disturbances may 
be mentioned the rest cure, the milk cure, the grape cure, 
and forced feeding or gavage. 

The rest cure, first devised by Weir Mitchell, plays an 
important role in the treatment of stomach disorders. 
This treatment is especially useful in cases of nervous 
stomach disorders. It is also useful in the treatment 
of ulcer, gastritis, and other conditions. The rest treat- 
ment in gastric di-sorders should be carried out for from 
six to eight weeks. The results that follow this plan of 
treatment are often marvellous. For a further considera- 
tion of the method and plan of conducting the rest treat- 
ment systematically, the reader is referred to the section 
dealing with that subject. 

Milk Onre. — The underlying principle of the milk cure 
consists in the ingestion of large quantities of milk, either 
alone or together with other foods. Under normal con- 

L lives exc! 
obese inc 


diCions, when taken alone in large quantities — say three 
liters a day — milk does not suffice as a food ; in certain 
digestive disturbances, however, milk given alone for a 
time forms a useful food and allows the stomach to regain 
its normal tone and functions. Milk is especially useful 
in the treatment of ulcer of the stomach and in certain 
forms of chronic gastritis; it is particularly useful in the 
secondary forms of gastritis, as those depending upon 
tuberculosis, anemia, etc. In some cases of nervous dys- 
pepsia milk cures sometimes effect remarkable results; 
whereas in others milk disagrees and, as a consequence, 
the milk cure can not be undertaken. When there i.s a 
diminution or an absence of acid in the stomach, miik is 
usually not well borne. It is contra-indicated in 
severe cases of muscular relaxation of the stomach and 
in intestinal conditions accompanied by extreme flatulence 
and chronic diarrheas. 

When milk is given in large quantities in addition to 
other foods, it is more frequently better borne and is less 
apt to disagree. One of the disadvantages of the milk 
cure is the obstinate constipation the milk is apt to in- 
duce. Milk can often be rendered more digestible by 
the addition of barley water, lime water, milk of magne- 
sia, and the like, or small quantities of coffee, tea, or 
whisky may be added to it. When milk disagrees, 
cream, buttermilk, kefir, kumiss, or matzoon may be 
given as a sub.stjtute for it. (See Milk Cure.) 

Forced Feeding or Oavage. — This method consists in 
introducing milk, eggs, and meat extracts into the 
stomach by means of the stomach tube. 

Qrape Cnre. — In this form of treatment the patient 
lives exclusively upon grapes; it is especially useful in 
obese individuals, in whom it is important to diminish 


the weight ; in aiicmia, girls suffering with dyspepsia, 
and in certain cases of nervous dyspepsia. 


Dysphagia may be due to any obstruction in the 
mouth, piiarynx, or esophagus. The difficulty and pain 
induced by swallowing must be obviated by lessening 
as much as possible the efforts at swallowing ; for this 
reason food must be givon in a concentrated form, and 
only in a liquid or semi-solid state; milk, ogg albumin, 
and the concentrated liquid beef preparations arc espe- 
cially useful in this condition. In those cases in which 
food can not be swallowed in sufficient quantities the 
patient must be fed through the stomach tube. In this 
way broths, gruel, milk, and the like can be passed into 
the stomach. 

Oser has said that " every case of acute catarrh of the 
stomach has a natural tendency to heal of its own accord 
unless a chronic form is produced by a mistaken diet or 
wrong medication." It is a generally admitted fact that 
in the treatment of this condition the diet plays the lead- 
ing role. The first step in the treatment consists of 
securing absolute rest for the stomach and a total absti- 
nence from food for at least twenty-four hours. This 
procedure is sometimes very difficult to carry out, for 
many patients believe that food is necessary for them, 
and that they can secure relief more quickly by taking 
nourishment. The nausea and vomiting which are present 
in more or loss degree in this condition, and which are 
aggravated by the taking of food, will soon convince the 
patient of the necessity of abstaining from food. The 



thirst is, however, so severe in these cases that patients 
may be allowed to rinse the mouth with water frequently, 
to retain tiny bits of ice in the mouth, or even to drink 
very small quantities of carbonated waters. With this 
p!an of treatment recovery generally follows in two or 
three days. After the first twenty-four hours feeding 
may be begun by giving cautiously small quantities of 
milk diluted with lime water, broths, and egg albumin ; 
these can gradually be increased in quantity, and during 
the next day or two boiled chicken, sweetbreads, scraped 
beef, in addition to toast, may be added. 

The authors are accustomed to prescribe the following 
diet about the second or third day after an attack of acute 
gastritis : 


150 gm. milk with lime water lOI 

100 gm, egg allnimln flavored uilh orange or lemoo juice, 53 

150 gm. bralh with e[!g S4 

150 gm. milk with ]ime waler loi 

5 gm. Armour's soluble beef in ualer lo 

100 gm. egg albumin flavored wiih orange or lemun juice, 53 

150 gm. milk with lime water 101 

After the third day the diet is increased as follows : 


7 A.M.: isogm, milk (101) Willi 7ogm. lua^i (1S2) aSj 

I) A. M. : 2 very soft-boiled eggs 160 

I A. M, : 200 gm, Ixmillon with i egg 85 

I P. M. : 100 gm. rice cooked in milk 177 

70 gm. toast . i8a 

3 p, M. : 100 gm. effi alliuniiii (53) with 50 gm. crackers (187) . 240 

S P. M. : 150 gm, milk with 70 gm. loaW 283 

7 P. M. : 100 gm. egg albumin flavored with orange or leu — '--■— "■ ' 

■ In comparing these <)iel lists slight discrepi 
of Ihe foods will be noted. These diffcrenci 
■ulhors using the caloric v.nlues of raw foods, » 
the values of cooked foods. In the diet list sg 
nine of foods as pcGpBre<l for ihe table are give 


teles in the calorie values 
i have ari.^eii from some 
aile others liavc computed 
I'M by the authors, calorie 




The dict<.-tic treatment of cliroiiic gastritis is of far 
greater importance than the treatment of this disease by 
the use of drugs. The diet must be varied according to 
the stage of the disease. The most easily borne forms 
of food are hquids, such as broths; unfortunately, these 
foods do not furnish sufficient nutriment to sustain the 
patient. Their nutritive value may be increased by the 
addition of beef extracts, eggs, barley and rice, peptones, 
somatose, etc. 

The diet should vary according to the character of the 
gastritis ; in those cases in which the gastric secretion 
has entirely or almost entirely disappeared, protein food 
is digested with great difficulty; it must therefore be 
given in the most digestible form ; of these foods, scraped 
beef, stewed beef, stewed chicken, broiled steak, and 
boiled sweetbreads are especially to be recommended. 
Vegetables should also be given in the most digestible 
form, best as a mush. Milk is useful in most cases; 
occasionally, however, it is not well borne ; when this is 
the case, it can be made more agreeable by adding small 
quantities of rice, potatoes, or cocoa to it, or kefir, 
kumiss, or matzoon may be substituted for it. In those 
conditions in which considerable acid still remains in the 
stomach, meats in various forms are very acceptable; to 
this list may be added fish and eggs ; vegetables, such as 
mashed potatoes, spinach, mashed carrots, especially in 
the form of purees, are to be recommended. In all in- 
stances fat should be given in an easily digestible form — 
as good butter, cocoanut butter, or Mehring's Vigor 
Chocolate. It is impossible to formulate exact rules as 
to the number of meals that should be eaten and the 


quantity that should be taken at each meal ; in a general 
way, small frequent meals are best borne. 

Water should be taken in small quantities between 
meals. Alcoholic stimulants or any strong stimulants 
should, as a rule, be omitted ; when utilized, they should 
be given in small quantities and best diluted with mineral 
waters. Salt and spices may be allowed occasionally in 
small quantities. 

The authors have found the following diet list useful 
in cases of chronic gastritis : 

8 A. H. : 200 Em. milk flavored wilh tea 135 

60 gin. stale bread (154) with 40 gill. bullEr (jz6} . . 4S0 

I soft-boiled egg So 

10 A. M. : 1 00 gm. scraped beef (119) with 60 gm. stale bread or 

toast (154) a73 

(or chicken sandwich (z6oj or 50 gm. thetry (60) 
withegB (80)) 

11 A.M.! Hoiiillon wilh egg 84 

loo gm. chicken 106 

(or 100 gm. Iamb chops (Z30) 
or 100 gm. broiled steak (209)). 

100 gm, spinach 166 

100 gro. Dioshed polatoes \^■^ 

100 gm. stewed apples 53 

60 gm. loast 154 

4F. M.: 120 gm. milk with lea Si 

30 gm. crackers 102 

7 F. M. : 60 gm. stale bread (154) wilh 40 gm. buUer (jz6) . . . 4S0 

zoo gm. milk 13 S 


Dilation of the .stomach may be either acute or 
chronic. The acute form is but rarely seen. Chronic 
dilation results either from a narrowing of the pylorus 
or from weakness of the muscular walls of the stomach. 
This latter form may be seen in diabetes, the insane, 
and in beer drinkers, as well as under many other con- 


In the dietetic treatment of dilation of the stomach, it 
must be remembered that fluids are badly borne, and 
must, therefore, be given only in very small quantities — 
not over i to i J liters a day. The fluids that are per- 
missible are milk, cream, coffee, tea, and bouillon, all in 
small quantities. The thirst that accompanies this dis- 
ease may be relieved by allowing the patient to suck bits 
of ice or by giving rectal injections of water or normal 
salt solution. Since nutrition is usually very faulty in 
this disease, nutrient enemata must frequently be em- 
ployed. When milk is administered, such substances as 
tapioca and rice should be added. Egg or concentrated 
meat extracts should be added to bouillon to increase its 
nutritive value. Meats should be given only in the most 
digestible forms ; of these, stewed chicken, boiled sweet- 
breads, calves' brains, and scraped beef are to be pre- 
ferred. Vegetables, such as carrots, spinach, peas, pota- 
toes, should be administered in the form of purees. 
Bread should be eaten stale ; wheat bread or toast is 
best. Stewed fruits, such as stewed prunes, and baked 
apples are also permissible. Since fats are apt to cause 
fermentation, butter should be allowed only in quite 
small quantities. Alcohol is not to be recommended in 
this condition ; if it must be used, it is best given in the 
form of some light wine. Strong spices should always 
be avoided. 

The special feature of the treatment consists in giving 
frequent concentrated meals. Patients with dilation of 
the stomach should be cautioned against visiting watering- 
places for the purpose of drinking the waters. 

The diet list given on the following page is the one 
used by the authors in dilation of the stomach. 



1. M. : loo gm. milk wilh tta . 67 

50 urn. Hale wlieal brca,! 130 

lOgn,. buLler to 

1. M. i 100 gm. raw scrajied Ijcef il8 

50 gm. toaal 130 

10 gra. butter 80 

50 c.c. slierry wine 60 

2 M. 1 150 gm. broiled steak 315 

□r l<|D gm. lamLi chups and chicken. 

100 gm. Iiaked polatiKS I27 

100 gm. spinach Iti6 

or loogm. a.-.paragus 1185), 

or 100 gni. peas, mashed and sirarned (318), 

■. M. ! 100 gm. cream 214 

SO gra. stale bread >30 

'. M. : too gTQ. boiled roekfish So 

50 gm. stale wheat brvad 130 

10 gm. butter So 


Since atonic dyspepsia is frequently caused by inju- 
dicious and too rapid eating, persons with feeble digestive 
powers should exercise especial caution to cat slowly, 
masticate thoroughly, and avoid indigestible food. Per- 
sons suffering from atonic dyspepsia should cat small 
quantities of food at frequent intervals. Since water is 
not absorbed in the stomach to any extent, it is advisable 
that the quantity of fluids taken .should not exceed \\ 
liters a day; this amount should include all fluids — 
coPee, tea, soups, etc. If the thirst is very great, enemata 
of water or nutrient enemata may be administered. 

The of milk in large quantities, as has been recom- 
mended, is not generaliy to be advised when the patient 
is able to go about, since the weight of large quantities 
of milk may overdistend the stomach ; when, however, a 
rest cure is instituted, milk is commonly well borne, even 
in very large quantities. The diet in atonic dyspepsia 


varies according to tlic nature of the gastric secretion. 
In cases in whicli there is ati excess of acid a liberal 
meat diet, consisting especially of chicken, beef, mutton, 
or ham, is to be recommended ; fish, eggs, hard- and soft- 
boiled, are also permissible; the vegetables should be 
selected with care ; carrots, peas, beans, and cauliflower 
may be given, but must be mashed and strained so as to 
rid them of cellulose ; potatoes, rice, and grits may also 
be allowed. Butter is the form of fat best suited to this 
condition. Alcoholic stimulants arc, as a rule, not well 
borne, and their use should be prohibited ; in a limited 
number of cases alcohol in the form of a light wine acts 
as a stomachic and may be prescribed. 

In those cases in which there is an absence or a dim- 
inution of acid in the gastric secretion, the lighter forms 
of meat, such as the white meat of chicken or fish, 
sweetbreads, stewed chicken, or raw scraped beef, should 
be allowed; vegetables, on the other hand, must be 
given in somewhat larger quantities. 

The treatment of the chronic constipation accompany- 
ing atonic dyspepsia, since it is one of the most constant 
symptoms, requires special mention. In the treatment 
of this condition the main reliance must be placed on the 
diet. Such forms of foods .should be given as will, in the 
course of digestion, produce substances that excite in- 
testinal peri.stalsis ; among these foods maybe mentioned 
Graham bread, certain vegetables, such as carrots, beans, 
tomatoes, peas, and turnips, macaroni, stewed and raw 
fruits, buttermilk, honey, and cider. This form of diet 
will often overcome the constipation without the aid of 
drugs. {For a more extensive con .si deration of the die- 
tetic treatment of chronic constipation, the reader is 
referred to the section dealing with that subject) 



The following list has been used by the authors in the 
treatment of atonic dyspepsia : 

7 A. M. : 40 gm. uraiigc juice 8S 

8 a. M,: 200 giQ milk I3S 

I soft-boiled egg So 

60 gra. toast 154 

40 gm. butter 315 

10 A. «, ; 100 gm. raw scrapei! beer itS 

60 gm. stale wheal bread 154 

12 M. : 100 gm. broiled steak jog 

or 100 gill, lamb cht>ps (230). 
or loo gm. slewed chicken ( ic5l. 

200 gm. a.sparagus - - . , . 37 

or 100 gm. peas (31S), 
or lOOgtn, spinach (1 65 j. 

\<x> gm. mashed potatoes 127 

loo gm. apple sauce S3 

50 gm. bread (stale) 130 

3 p. M. : 200 gm. milk 135 

Co gm. wheat bread 154 

40 gm. butter 315 

7 F. M. : ICO gm. bolted rock-fish So 

too gm. milk 67 

60 gm. bread 154 

40 gm. butter 315 



Much can be done by a carefully selected diet to pre- 
vent the onset of an ulcer of the stomach. As soon as 
the very first .symptoms become manifest, the ])atient 
should be placed upon an absolute milk diet. The tem- 
perature of the food should be regulated, so that it be 
not given too hot nor too cold. 

Boas divides the treatment of ulcers of the stomach 
into several stages : 

Stage of Hemorrhage.— In this stage ]}oas advises 
ab.solute rest in bed ; the patient not even being allowed 
to arise for purposes of defecation or urination. No 
nourishment whatever should be given by the mouth. 
In robust individuals even nutrient enemata may be 


omitted. If the patient is weak or in feeble condition, 
feeding by the rectum may be instituted. (See the sec- 
lion on Nutrient Knemata for the method of preparation 
and utilization of this mode of feeding.) Only two or 
three nutrient enemata are to be given daily. Boas 
carries out this plan for three or four days. After this 
he gradually begins mouth-feeding, the nourishment con- 
sisting exclusively of fluids given at a temperature of 
98° to 100° F, He prefers milk diluted with lime water, 
- with tea, or with coffee. In addition he permits beef tea, 
freshly expressed or artificial beef juice, and egg albu- 
min. The carbonated waters, such as Vichy, are also 

After the first week Boas begins the regular Leube 
and V. Ziemssen ulcer treatment, which he conducts as 
follows : The patient is given a one-fourth liter of Carlsbad 
water, which he drinks in bed morning and evening. 
Hot-water applications are placed on the abdomen. The 
diet during this stage consists mainly of milk in addition 
to other fluids. If the patient is very weak, nutrient 
enemata may occasionally be given. 

In the treatment, beginning with the third and continu- 
ing during the fourth week, Boas permits the patient to 
recline on a couch and continues the use of the Carlsbad 
water, which should be given for four weeks from the 
time it is first taken ; he advises that the diet still consist 
mainly of milk, although he now permits the addition of 
soaked zwieback, scalded crackers, and soft rolls. Meats 
(sweetbreads, brains, meat balls), fish (perch, oysters in 
small quantities), in addition to the light red wine and 
carbonated waters, are also allowed. 

After the fourth week, if the patient is doing well, 
Boas adds from 50 to 200 gm. of mashed potatoes, 

^^^^ tirely by 
^^^k saiy for 


stewed fruits, and vegetables, such as spinach, carrots, 
peas, and turnips, in the fonii of purees, to the diet pre- 
viously given. The meats (broiled steak, chops, and 
roast beef), if well coolced, can finally be given more 
liberally. According to Boas, the patient should avoid . 
raw fruit, acid and highly seasoned foods, and also very 
hot and very cold drinks for many years. Even in those 
cases in which there has been no hemorrhage, Boas never- 
theless advises the rest treatment. It is generally admitted 
that the rest cure is the only satisfactory plan for treat-, 
ing cases of ulcer of the stomach. Leube and Penzoldt 
have devised dietaries for these cases ; these have been 
given elsewhere (see p, 180). The first dietary should 
be followed for ten days; the second, for the succeeding 
ten days ; the third, for about eight days. The severity 
of the condition in each case must, of course, determine 
the length of time during which each dietary must be 
continued. In all instances milk seems to be the most 
useful form of food during the first weeks of this rest 
treatment. Occasionally milk does not agree, and sub- 
stitutes must be given in its stead. Of these, buttermilk, 
kefir, matzoon, and kumiss are especially to be recom- 


As soon as hemorrhage from the stomach occurs the 
patient should be put to bed and not allowed to rise. A 
light ice-bag should be placed over the region of the 
stomach, and no food or drink whatever should be allowed ; 
in order to quench the thirst, small quantities of ice may 
be given the patient to suck. Nourishment must be en- 
tirely by the rectum ; but even this is usually unneces- 
sary for the first few days, in order to combat the 


weakness following great loss of blood, salt solutions may 
be injected into the rectum, or if the patient is very weak, 
coffee, meat juice, or whisky may be added to the enema. 
In very grave cases salt infusions must be resorted to. 


In tiie dietetic treatment of cancer of the stomach 
milk forms the most important article of diet. The 
more easily digestible forms of meat, such as sweet- 
breads, scraped beef, calves' brains, and stewed chicken, 
are permissible. In this disease there is usually a distaste 
for meat, and fish may be substituted for it ; of these, 
boiled mackerel, rock, haddock, or trout are to be recom- 
mended. Of the vegetables, mashed potatoes, spinach, 
carrots, peas, beans, cauliflower, if mashed and strained 
so as to rid them of celluSose, are admissible ; rice, farina, 
and corn starch with milk are also valuable forms of food. 
Milk with tea, coffee, or cocoa, or wine or whisky may be 
given for the thirst. Fluids should, however, be taken 
in small quantities at a time. In order to supply the 
necessary quantity of fat, butter or Mehring's Vigor 
Chocolate i.s to be recommended. In these cases it is 
often important to promote the general nutrition by means 
of rectal alimentation. In cases of cancer of the stomach 
too abundant a diet should not be insisted upon, as at 
best but little can be gained by this method of treatment, 
When the growth is at or near the cardiac portion of the 
stomach, the diet should be such as will prevent so far 
as possible any irritation of the diseased esophagus and 
stomach. Solids should therefore be avoided. Milk is 
the food that is usually best borne in this condition. 

The authors have found the diet list given on the follow- 
ing page useful in many cases of cancer of the stomach : 




8 A, M. : 150 gm. miik with lea .... - loo.o 

50 gni, loa:.l 130.0 

to A. M. : loo yni. laked Iroul I06.O 

loogm. milk orjogm. (57-5) . . 67.0 

Sogm. loast 130.0 

50 gm. .iherry 60.D 

13 H.: Buuillon with 5 gm. somaluse 16,0 

100 gm. chicken 106.0 

ot 100 gm. calves' EWeelLiieaJs (90), 
<ir 100 gm. calves' brains (140), 
or 100 gm. squab (loo)- 

100 gm. nia^hed pot.iloeii 127,0 

or 100 gm. spinach (l6l3). 
or 100 gni. asp.-iragiis (iB). 

25 gm. stale wheal breari 65.0 

4 p. M. : 5ogm. toast IjO.O 

20 gm. butter . 162.0 

40 gin. caviare 52.O 

71- «.r 150 gm- milk (loo) *ilh 5 gm. 5omalose (it) . 116.0 

100 gm. rice cookeii in milk .- - - 177-0 

50 gm. wheal bread '.lo.o 

9 P.M.: 30 gm, Panopeplone ■ 57-5 



Nervous Vomiting. — This is often overcome merely 
by isolation and change of scene. In severe cases patients 
should be placed in bed ; they are best fed on semi-solid 
or liquid food, since the latter is more easily retained 
than solid food. It should be given in very small quan- 
tities; scraped beef, eggs, rice, and toast are especially 
useful. Cracked ice will often afford relief The most 
indigestible forms of food are frequently well borne when 
the most digestible are speedily vomited. In severe cases 
the patient should be fed for some days exclusively by 
rectal alimentation. 

Diet in Nervons Dyspepsia. — In this condition the 
diet should not be too restricted. Strengthening food, 
without any attempt at a too rigorous diet, should be 


prescribed. In those cases in which milk is well tolerated, 
it should be given in targe quantities ; when it is not well 
borne, buttermilk, kefir, or kumiss may be substituted for 
it. The patient's appetite should be humored, and he 
should be allowed to eat any food he can digest. Aico- 
holic stimulants should be prohibited, or given only in 
very small quantities. In severe cases a well-conducted 
rest cure will produce the best results. 


The diet plays quite as important a role in the 
treatment of diseases of the intestine as it does in the 
treatment of gastric disorders. In many intestinal dis- 
turbances, such as acute intestinal catarrh, diarrhea, etc., 
cures often can be effected by diet alone, when without 
this mode of treatment the disease might become in- 
tractable. The diet in intestinal diseases, as in gastric 
disorders, must be such as will produce no annoying 
symptoms. The process of digestion in the intestine is 
exceedingly complicated, and therefore the digestibility 
of foods in this part of the alimentary tract is most diffi- 
cult to determine. 

It has been shown that certain forms of food contain 
very large proportions of protein matter, but that their 
absorbability is so slight that their nutritive value is far 
lower than that of foods containing less protein. Thus, 
while peas contain considerably more protein (7 per cent.) 
than does milk (3.7 per cent), a much smaller proportion 
of protein is absorbed in the case of the former than in 
that of the latter ; on the other hand, the absorbability 
depends greatly on the mode of preparation of the food ; 
when vegetables are mashed and then strained, so as to 
rid them of their cellulose envelopes, they are much 
more readily absorbed than when eaten with the cellulose. 
The digestibiUty of certain foods in the intestine varies 


greatly with different individuais. For this reason exact 
rules can not be formulated in any case, but the diet must 
be varied according to individual peculiarities. Boas has 
expressed his opinion on this subject as follows : 

" 1. In a number of intestinal diseases a change of diet 
is unnecessary or may even be harmful. 

" 2. In some cases special dietetic restrictions are di- 
rectly indicated, but these should be as few as possible. 

" 3. In another series of cases an abundant, heavy, not 
easily digestible or absorbable diet is indicated, 

"4. The general aim of our treatment should always 
be to so manage the case before us that digestion of a 
norma! diet will always occur in the alimentary canal 
without any subjective or objective disturbances. Under 
these circumstances only can the case be considered 

According to their effect on intestinal movements, foods 
may be divided into three clas.'ses: those producing con- 
stipation ; those producing a laxative effect, and those 
exerting no especial effect in either direction. In the first 
class are those foods containing an astringent, such as 
tannin ; among these may be mentioned certain red 
wines, cocoa, and tea. Rice, tapioca, barley, sago, maca- 
roni, and potatoes have a tendency to produce constipa- 
tion in many individuals. Among the laxative foods may 
be mentioned fruits and certain vegetables, as cucumbers, 
tomatoes, and cabbage ; cider, buttermilk, beer, and the 
carbonated waters also exert a laxative effect. 

In the third class, foods that have no especial effect 
on the intestinal movements, may be placed meats, fish, 
eggs, toasted bread, and zwieback. It must be remem- 
bered, however, that certain foods that prove laxative in 
one individual may be constipating in another, so that no 



precise rules can be formulated; in each case individual 
tendencies must be consulted. 

In severe forms of intestinal disturbances rectal ali- 
mentation must often be resorted to. For a further 
consideration of the technic and forms of food to be 
utilized in this method of feeding the reader is referred 
to the section on Rectal Feeding. In those cases in 
which food can not be given either by the mouth or by 
the rectum, subcutaneous feeding becomes necessary; 
for this purpose olive oil maybe used; one ounce may 
be injected twice daily under the skin, best in the region 
of the thigh ; in some cases normal salt infusions are 

The management of the diet in intestinal disorders is 
often difficult. It requires great experience and judg- 
ment to determine what particular foods should be given 
the patient and also to know how long they should be 
continued. It frequently requires great tact and patience 
on the part of the nurse to see that the directions of the 
physician are carried out. 


In intestinal dyspepsia food should be given frequently 
and in very small quantities. At first only the liquid 
forms should be used, such as weak tea, peptonized milk, 
malted milk, bouillon, and egg albumin ; after a few 
days the patient may gradually be placed on the follow- 
ing diet : calves' brains, sweetbreads, bioiled steak or 
lamb chops, soft-boiled eggs, boiled fish, such as mackerel 
or rock ; baked potatoes, spinach, asparagus, and stewed 

The list on the opposite page gives the general plan 
of a diet used by the authors in this condition ; 


M. : 150 (jm. milk with lea 101 

1 soil-boiled egg go 

6ogni. toasted Hhcai bread (155) wjiii 20 gm, builer 

('63) JlS 

M. ; ScrapeJ-Leef sandwich] 'f" S'"- sa^ped beef ( . 18) 1 

I 50 fim. wheat bread (178) f ^^ 

! Bouillon willi s gm. Armour's Soluble Beef ...... 10 

100 gm. liroileii chicken 106 

ot 100 gm. broiled sleak {209), 

SOgm. maahedpotatoes or loogm. bpinach |[66) . . . 64 

100 gm. apple sauce 88 

50 gm. wheat bread, stale or as loasl 130 

3 P.M.! 200 gm. milk 135 

7 r. M. : 200 gm. milk with rice 253 

I sofl-boii&i egg 80 

100 gm. wheat bread antl 50 gm. butter 666 

As in acute ga.stric catarrh, so also in acute intestinal 
catarrh the regulation of the cJiet i.s probably the most 
important factor in the treatment of the disease. The 
patient should be kept in bt-d ; after the bowel has been 
thoroughly emptied by a cathartic, liquid foods, such as 
clear broths — at first without and then with cggs^thin 
gruels, light tea, cocoa cooked in water, and egg albu- 
min, should be given exclusively for several days. In 
this condition milk should not, as a rule, be given. 
When there is extreme thirst the carbonated waters may 
be allowed, but only in small quantities. The thirst is 
best relieved by placing bits of crushed ice in the 
patient's mouth. After the pain and discomfort have 
disappeared, toast, crackers, stewed chicken, soft-boiled 
eggs, mashed potatoes, and boiled rice may be added to 
the diet; indigestible foods, such as raw fruits, heavy 
vegetables, and fatty and acid foods, should be avoided 
for a considerable period of time after the catarrh has 



The dietetic treatment in chronic intestinal catarrh 
depends upon the condition of the fecal movements; 
these arc, in a measure, an index as to the portion of the 
bowel involved. Cases of chronic intestinal catarrh may 
be divided into those cases associated with chronic con- 
stipation, those associated with chronic diarrhea, and 
those in which diarrhea alternates with constipation. 

Diet in Chronic Intestinal Catarrh Associated 
with Chronic Constipation. — In this condition a 
mixed diet containing, so far as possible, those sub- 
stances that stimulate the intestinal peristalsis should 
be prescribed. Astringents and anything that tends to 
produce constipation, such as cocoa, chocolate, tea, red 
wines, rice, farina, etc., should be avoided. 

The following foods should be prescribed in cases of 
chronic constipation : Graham and rye breads with butter, 
fruit, buttermilk, kefir, cider, beer, fresh vegetables, as 
cabbage; sour krout, and salads. Fats are especially to 
be recommended, and honey is also useful. Salts stimu- 
late the intestinal movements, therefore foods containing 
salts are indicated in this condition ; among this class 
may be mentioned herring and caviare. Sugar, espe- 
cially milk sugar, has a marked tendency to increase 
intestinal movements. Water taken cold or on an empty 
stomach will also .stimulate intestinal movements. 

Diet in Chronic Intestinal Catarrh Associated 
with Chronic Diarrhea.— When severe symptoms, 
.such as intense diarrhea and pain, present themselves 
the patient must be put to bed and kept on a very rig- 
orous diet ; the period of rest may be lengthened or 
shortened according to the severity of the disease. In 


moderately severe cases several weeks will usually suffice. 
Nourishment should be taken in small quantities every 
few hours; sufficient must, however, be given to main- 
tain the body weight All cold drinks or carbonated 
waters, fruits, cabbage, and salads are to be avoided. 
The most suitable foods in this disorder are broths con- 
taining barley, rice, and farina; soft-boiled eggs, sweet- 
breads, stewed chicken, broiled steak, boiled fish, toast, 
crackers, baked potatoes, tea, milk (boiled), and cocoa; 
in many cases port wine is quite useful, as it contains 
tannin, which acts as an astringent to the bowels. In 
this condition milk, even when boiled, is often not well 
borne, and must then be avoided. 

In conditions of chronic intestinal catarrh in which 
diarrhea alternates with constipation, the same plan of 
treatment may be followed as has been described for 
those cases accompanied by constipation or diarrhea; it 
is especially important to treat by diet the more prom- 
inent symptoms, whether it be diarrhea or constipation. 
Mineral waters are frequently utilized in cases of chronic 
intestinal catarrh. For cases accompanied by constipa- 
tion the waters of Marienbad and of Saratoga (Congress 
and Hathorn Springs) are most beneficial. Where diar- 
rhea is the prominent symptom, Carlsbad and Vichy 
are to be recommended. 


The diet in acute dysentery is similar to that pre- 
scribed in acute intestinal catarrh. The patient is put to 
bed and only liquid foods are administered. Of these 
the most suitable are bouillon, broth, egg albumin, and 
tea; gradually, as the condition improves, .semi-solids, 
such as milk toast, rice cooked in milk or broth, gruels 



of tapioca, etc., may be prescribed. Solid food should 
be abstained from until a few days after the disorder has 

In chronic dysentery the food should be given in 
small quantities at frequent intervals. All coarse, indi- 
gestible food .should be avoided. In other respects the 
diet is similar to that already given under Chronic Intes- 
tinal Catarrh. 


The diet in ulcer of the intestine is the same as that 
for ulcer of the stomach, and the reader is referred for 
the details to the section dealing with that subject. In 
cases accompanied by hemorrhage absolute rest in bed 
must be insisted upon, and rectal alimentation adminis- 
tered if necessary. In any form of ulcer the diet should 
be non-irritating and easily digestible. Among those 
foods that may be given are milk, eggs, rice, farina, sago, 
all forms of broth, especially chicken and mutton broths; 
sweetbreads, stewed chicken, baked potatoes, mashed 
potatoes, tea, cocoa, crackers, and toast. 

The medical treatment in malignant growths of the 
intestine is only an adjunct to the surgical treatment 
always indicated, and consists solely in treating the 
symptoms as they arise. The diet should be highly 
nutritious and at the same time easily digestible ; small 
quantities of food should be given at frequent intervals. 
Milk, broths, soft-boiled eggs, raw scraped beef, sweet- 
breads, baked and mashed potatoes, vegetables, such iis 
carrots and peas, that have been finely divided and 
strauied, stewed fruits, toast, and crackers are permissible. 


The trcatniL'iit of acute intestinal obstruction, except 
when due to the impaction of a foreign body, when it 
may possibly be passed through the bowel, is purely sur- 
gical. Previous to operadon the following dietetic reg- 
ulations should be carried out: The patient should be 
kept in bed, and in the acute attacks all food should be 
withheld. Thirst may be quenched by small bits of ice 
kept in the mouth or a few drops of hot water may be 
given at frequent intervals. If the disease extends over 
a period of several days, rectal alimentation or the admin- 
istration of salt solutions must be resorted to. 


In this condition the diet should chiefly be liquid or 
semi-solid. All indige.stible food should be avoided, 
especially those forms that are apt to leave a large 
amount of residue in the bowel. The foods to be 
avoided are salads, heavy vegetables, and fruits. Milk 
broths, eggs, broiled meats, chicken, sweetbreads, boiled 
fish, rice, farina, toast, crackers, and butter are permis- 
sible. In advanced cases rectal feeding must be carried 


The dietetic treatment hi this be governed 
by the symptoms, for surgical treatment is usually indi- 
cated. The patient should be put to bed and under no 
condition be allowed to rise until recovery is complete. 
During the first days Sahli and Penzoldt recommend that 
all food be withheld ; liquids, such as egg albumin, weak 
tea, thin broth, barley or rice water, or milk diluted with 
lime water, may be given in small quantities when deemed 
necessary. When the acute symptoms have subsided 



this diet can bt increased somewhat; the milk may be 
taken undiluted and eggs may be added to the broth. 
When the pain and fever have disappeared entirely, 
gruels made of rice or barley, soft-boiled egg, scraped 
beef, stewed chicken, toast, and crackers may be added 
to the list; still later mashed potatoes and vegetables — 
finely divided and strained — may be allowed, and finally, 
when the patient is well, the usual diet may be resumed. 

Ochsner advises the following plan of treatment in all 
cases of appendicitis in which operation is to be per- 
formed, believing that it reduces the mortality and 
changes the class of cases in which the mortality is 
greatest into another class in which the mortahtyis very 
small after operation : 

" In every case of acute appendicitis all food by mouth 
and all cathartics are prohibited. In case the patient 
suffers from nausea or vomiting, gastric lavage is at once 
employed. In the milder cases the patient is permitted 
to rinse the mouth with cold water and to drink small 
sips of very hot water at short intervals. In the severer the patient is permitted to rinse the mouth with 
cold water, but is not permitted to drink either hot or 
cold water for the first few days until the acute attack 
has subsided, when the use of small sips of hot water is 
begun. If the nausea persists, gastric lavage is repeated 
once or twice at intervals of two to four hours, in order 
to remove any substance which had regurgitated into the 
.stomach from the small intestine. 

"The patient is supported by nutrient en em ata. con- 
sisting of an ounccof oneof the concentrated predigested 
liquid foods in the market, dissolved in 3 oz. of warm 
normal salt solution, introduced through a catheter 
which is inserted a distance of 2| to 3 inches. In case 


this gives rise to pain or irritation or nausea, it is inter- 
rupted for twelve to twenty-four hours at a time. In 
cases in which no water is 'given by mouth, an enema of 
8 oz. of normal salt solution is given four to six times 
a day in addition to the nutrient cnemata. In cases 
operated during the acute attack this treatment is con- 
tinued for several days after the operation. 

"After the patient has been free from pain and other- 
wise practically normal for four days he is first given 
from 1 to 4 oz. of weak beef tea, preferably prepared 
from commercial beef extract, every two hours. In a 
few days one of the commercial predigested foods, dis- 
solved in water, is substituted ; still later, equal parts of 
milk and lime water; then general liquids, then tight 
diet; and finally, after the patient has fully recovered, 
full diet is given." 

This condition resembles nervous dyspepsia. At times 
the most indigestible food is well borne, whereas the 
digestible forms create discomfort ; in each case it is 
important that the diet be regulated according to the 
patient's digestive powers. Generally a liberal diet is 
indicated in these cases ; in many instances a systematic 
rest cure is needed to bring about relief 

Flatnlence. — This condition is characterized by an 
excessive accumulation of gas in the intestine. In the 
dietetic treatment, therefore, foods that tend to produce 
large quantities of gas, such as beer, cider, carbonated 
waters, fruit, cabbage, rye and Graham breads, and 
potatoes, should be avoided. The disorder is often of 
purely nervous origin, and when this is the case unre- 


stricted diet is to be recommended — one that will tone 
up the patient's system and thus cause the flatulence to 


Since constipation is often a frequent cause and accom- 
paniment of hemorrhoids, it is important that this condi- 
tion be corrected. As has been pointed out elsewhere, 
proper diet plays an important role in the prevention of 
chronic constipation. Patients afflicted with hemorrhoids 
should eat in moderation, but should avoid all excesses 
of food and drink. An abundance of outdoor exercise, 
consisting of walking and simple gymnastics, should be 
indulged in ; violent gymnastics and horseback-riding 
should be avoided. A daily evacuation of the bowels 
should be secured. Patients with hemorrhoids should 
avoid alcoholic beverages, spiced foods, strong coffee 
and tea, cheese, cabbage, and beans. The foods most 
suited to this condition are potatoes, carrots, spinach, 
asparagus, and even salads, since they stimulate intestinal 
peristabis and thus help to keep the stools soft. Stewed 
and raw fruits, including grapes, oranges, pears, and 
apples, are also beneficial. Water is the beverage 
in this condition. The waters of Carlsbad, Kissingen, 
and Saratoga are most beneficial ; they act best when 
taken at the springs. 


The dietetic treatment of diarrhea niu.'it vary accord- 
ing to the type of the disorder. In the nervous variety 
the patient should be instructed to restrain his bowel 
movements except at a certain hour in the morning. 
Under all conditions it is important to exclude from the 



diet all foods that have a tendency to stimulate the 
intestines. Coarse, indigestible foods, especially those 
containing a large percentage of cellulose, must be 
avoided ; in this class are especially to be mentioned 
cabbage, pickles, salads, turnips, carrots, all cold drinks, 
carbonated waters, and beverages (including champagne 
and beer). Among the foods to be recommended are 
broths, tea, red wines, farina, rice, and barley gruels. 
Raw milk usually has a laxative effect, but when boiled 
or diluted with lime water or brandy it is constipating, 
although in a certain number of cases it must be entirely 
excluded, as it increases the number of movements. In 
a number of cases of chronic diarrhea milk cures have 
been given with good results. The authors have suc- 
ceeded in relieving cases of chronic diarrhea by sys- 
tematic rest cure. 


•t Authors' Diet List far Mo,i,-rate Cases of C/ironic Diarrhea. 


1. : 200 gm. of cocoa (cooVed in water) 45.0 

2 soft-boiled eggs tto.o 

SO 1^. toast 130.0 

[, : 250 gm. broth with i egg 80.O 

30 gm. Panopeptone 57.5 

250 gm. broileil cliicken 212.0 

30 gm. toast 130.0 

100 gm. raasheil potatoes a45.o 

1. : 50 gm. Panopeplone 57.5 

1 soft-boiled egg So.O 

200 gni. cocoa (coined in Wilier) 45.0 

50 gm. toast 130.0 

I. : TOD grti. lice Cijoked in bouilhm .......... 34.O 

50 gm. wheat bread I30.0 

1. : 100 gm. raw scraped beef iiS.o 

SOgm. Panopepwne 57.5 

50 gm. toa-sl 1300 





In the dietetic treatment of habitual constipation it is 
essential that the food that is ingested should be such as 
will increase the intestinal movements. Those foods 
that leave a large bulk of fecal matter arc useful for 
this purpose. Those that leave a small residue are most 
apt to produce chronic constipation. A diet consisting 
principally of eggs and milk with only a small quantity 
of vegetables and water is one that is constipating. 

A glassful of cold water taken before breakfast will 
often regulate the bowels; occasionally, according to 
Penzoldt, a pinch of salt added to the water will increase 
its efficacy; raw or cooked fruit, taken on an empty 
stomach morning or evening, occasionally gives good 
results. It is a well-known fact that the smoking of a 
cigar in the morning will often stimulate intestinal move- 
ments. The patient should recognize the importance of 
having an evacuation of the bowels at the same time 
each day. 

Chronic constipation is a frequent accompaniment of 
dyspeptic disorders, and may be relieved by appropriate 
treatment of the gastric disorder. It should not be for- 
gotten that habitual constipation is frequently induced 
by the persistent use of cathartics, and the use of drugs 
should be avoided as much as possible in the treatment 
of this disorder. Sedentary habits are often the cause 
of constipation, and for thi.'; reason proper exercise 
should always be prescribed along with the dietetic 
treatment. The vegetables that are especially useful in 
the treatment of chronic constipation arc spinach, peas, 
cauliflower, cabbage, asparagus, salads, onions, celery, 
and tomatoes. The cereals that stimulate the intestinal 



movements are oatmeal and commeal. Graham, rye, 
com, whole wheat, and bran breads are also useful. 
Other foods classed as laxatives are honey, cider, molasses, 
and acid fruits, such as apples, pears, peaches, cherries, 
and oranges. On account of the acids and seeds they 
contain, berries are effective laxatives. Prunes, dates, 
and figs are also to be recommended. 

Habitual constipation is often due to the fact that water 
is taken in insufficient quantities ; therefore, in the treat- 
ment of the disorder, an abundance of water must be pre- 
scribed. The foods to be avoided are tea, claret, cocoa, 
chocolate, rice, barley, and farina gruels, and huckle- 
berries. In some cases milk acts as a laxative, whereas 
in others it has the opposite effect. For this reason its 
effect should be tested tn every case. Boiled miik usually 
constipates. Buttermilk is preferable to sweet milk as a 
laxative. Most cases of habitual constipation can be 
relieved or cured by the dietetic treatment here laid 

Boas ' has recently called attention to the fact that in 
a certain class of cases of chronic constipation, excellent 
results are obtained by the rest cure. The patient is 
isolated for fourteen days and is not allowed to leave 
his bed. The nourishment of the patient is regulated 
for each day, and for each meal. No effort is made to 
increase the patient's weight, although great importance 
is attached to giving food regularly. The treatment is 
continued for from four to .six weeks. 

It is not within the province of this book to discuss 
the value of massage and electricity; suffice it to say 
that they are reliable adjuvants to the treatment of con- 

' Boa.!, Iiilirnnlhiial ClinUs, vol. iii., l4Lh .Series, 1904. 



The authors frequently prescribe the folk 
cases of chronic constipation : 

wing diet in 


1 8 A. M. : 300 gm. milk wilh coffee 

1 2 sufl-boileil e^.^ 

1 150 gm. Grah.iin bread 

1 40 gni. hutler 

1 10 A. M. : 400 gm. cider 

L 12 M.; 200 gm. htolh. wiib 1 p^ 

. . 192 
. . 160 

■ 371 

■ .326 
. .280 
. . 84 

^^K i^!:::'^™? 

^^^^H 150 gm. Uraham bread 

^^^^ 200 gm. slewed apples 

■ 4 r. M. : 400 gra. buitermilk 

7 \: M. : 100 gin. scraped beef 

1 IS*'G'"' tJraiiam bread 

. . 166 

. . iiS 

9 V. M. ; 40 gm. figs (0. 400 gm. Imllermilk) 


, ^6 


Acute Peritonitis. — TJie diet in acute 

peritonitis is 

purely of secondary importance and requires considera- ^| 

; tion only until operative procedure can be undertaken. ^| 

No food whafpver .i^liould be ;;ivcn bv the mouth : if | 

necessary, rectal alimentation should be rest 

rtcd to. If H 

operation is not undertaken and vomiting has ceased, ^^t 
fluids may be given in a few days. Foods that may be H 
prescribed are milk and lime water, diluted broths, and H 

egg albumin with or without brandy or . 
very small quantities should be taken at a 
frequent intervals ; gradually plain milk, 
gruels may be added to the list ; solid food 

lierry ; only H 
time, but at fl 
broth, and ^| 
.should not ^1 

be allowed for several weeks. When stimulants are re- ^| 

B quired they should be given in the form 
I brandy, or champagne. 

of whisky, H 


Chronic Peritonitis, — The diet in chronic peritoni- 
tis should consist of boiled meats, eggs, milk, stale bread, 
toast or crackers, and vegetables, only, however, in the 
form of purees; carbohydrates should be eaten sparingly 
on account of their tendency to ferment. Food should 
be eaten in small quantities at regular but frequent 



Certain general principles of dietetics apply to all dis- 
eases of the liver. The condition usually called " bilious- 
ness " is a cry of the liver for relief from overwork. The 
administration of calomel or a saline laxative followed by 
a few days of restricted diet is all that is necessary in 
most cases. In general it may be stated that in diseases 
of the liver the food should be easily digested and con- 
sist of a mixture of proteins, carbohydrates, and fats. In 
many cases it is desirable to limit or even to avoid alto- 
gether both fats and carbohydrates. 

Certain articles of diet are known, while others are 
believed, to be injurious in diseased conditions of the 
liver. Overeating is injurious ; first, on account of the 
overwork it necessitates; and secondly, because the 
superfluous food is apt to undergo putrefaction. The re- 
sulting bacterial products are believed to act on the liver 
in much the same manner as does alcohol. The exces- 
sive use of alcohol produces marked changes in the liver 
in certain individuals. 

In all liver diseases alcohol should be avoided unless 
specially indicated as a tonic or stimulant. In any case 
it should be given well diluted. A well-matured pure 
whisky well diluted with water is to be preferred, and 
this is only in the smallest possible amount. 

Certain foods have been regarded as " stimulating '* or 





I ad 

" irritating " to the liver. Among these are peppers of 
various kinds, spices, mustards, concentrated meat ex- 
tracts and meat broths, and the substances formed in 
roasted and baked meats. To be proscribed are peppers, 
radishes, horseradish, onions, watercress, and celerj'. 
Salt in too large quantities is also to be condemned. 
Strong coffee and tea are harmful, but weak tea seems 
to be well borne in many cases. 

In severe diseases of the liver the diet usually be 
restricted to milk, diluted or peptonized ; gruels, albumin 
water, kumiss, buttermilk, and bland broths, such as 
oyster broth. Orange juice as well as lemonade may 
generally be allowed. 

In the milder diseases and during convalescence the 
diet need not be so rigid, and lean meat, curd, junket, 
bread, toast, zwieback, fresh fruit, or stewed fruit with 
little or no sugar, may be allowed. In the chronic cases 
and lighter forms the following articles may help to make 
up the dietary: Milk, variously diluted and prepared; 
buttermilk, curd, kumiss, custard, junket, eggs, lean 
meat— if beef or mutton, preferably rare — sweetbreads, 
chicken, squab, liver, the soft part of oysters and the 
more digestible forms of fish. Fresh green vegetables 
and green salads without oil are permissible. Small 
quantities of well-baked or boiled mealy potato may be 
allowed once a day, for many persons do not relish a 
meal that does not contain potato in some form. The 
.starchy foods should be partaken of somewhat sparingly ; 
bread, toast, zwieback, pulled bread, and biscuits (crackers) 
may be permitted. Small quantities of cereal foods may 
be taken ; rice, sago, and tapioca, when sufficiently well 
cooked, may be allowed. Fresh fruit is a valuable 
adjunct to the diet. Oranges, grape-fruit, ripe peaches 


or pears, strawberries, ripe plums of the most tender 
varieties, may all be taken. Stewed fruits only slightly 
sweetened and baked apples may be allowed with advan- 
tage. If there is constipation, stewed prunes are useful. 
Lemonade may be taken as a beverage. 

Mineral waters may be drunk freely if dropsy is not 
present, and are best taken on rising and between meals. 
Hot water is a valuable substitute for the mineral waters. 
It is especially useful in allaying thirst when there is 

The food should be taken slowly, well masticated, 
and never in too large quantities. If necessary, more 
miik may be given, so as to make large amounts of 
other food unnecessary. The patient should lie down 
directly before and after meals. In no case should 
the patient eat immediately after taking active exer- 

In certain chronic conditions, such as hyperemia, fatty 
degeneration, and chronic hepatitis, exercise is to be 
taken at proper times. 

In summer and in warm climates more vegetables are 
to be allowed and less meat. If putrefactive changes 
take place in the intestine, a diet consisting of white of 
egg and water should be maintained until this condition 
is overcome. When the putrefaction is caused by tor- 
pidity of the hver, it may sometimes be prevented by 
increasing the amount of vegetables and by the use of 

Diet in Gall-stone Disease. — The meals should 
be taken at regular intervals and not too widely sepa- 
rated. Prolonged fasting should not be permitted. A 
substantial breakfast should be taken when not other- 
wise contra-indicated, and not the simple " continental " 


breakfast of coffee and a roll. A late supper is of value, 
and it may be advisable in some instances to give the 
patient nourishment at night. Fat should be reduced to 
a minimum or avoided entirely, and the starches and 
sugars limited in amount. 




Pleurisy. — Two plans of dietetic treatment may be 
followed. The first is to place the patient on a milk 
diet. The second is to place the patient on a " dry 
diet.*' This consists of the ordinary diet with the fluids 
limited in amount. No soups, but little tea or coffee, are 
allowed, and but small amounts of water. The milk 
diet is preferred where there is fever or complicating 
heart or kidney disease. 

Empyema {Pus in the Pleural Cavity), — As nourish- 
ing a diet as is possible should be used according to the 
general principles of feeding fever patients. 

I/aryng^tis. — In chronic disease of the larynx there 
may be great pain on swallowing. All hard and highly 
seasoned foods are to be avoided. Only semi-solid and 
liquid foods should be given. The physician sometimes 
prescribes drugs to allay the irritation in the throat at 
meal time. 

Difficulty in swallowing may sometimes be overcome 
by the following two methods : By allowing the patient 
to lie flat on a lounge with his face over the edge. Food 
is to be sucked through a tube from a vessel placed im- 
mediately below. The second method consists in direct- 
ing the patient to lean forward while eating. 

Asthma. — Certain forms of asthma may be brought 
on by errors in diet leading to attacks of indigestion. 



Patients suffering from this should partake oiiiy of easily 
digested food and should lead regular lives. The meals 
should be taken at regular intervals. Dinner should be 
eaten in the middle of the day and the supper should 
be light. Late suppers should not be taken, and eating 
between meals should not be allowed. 

Diet in Chronic I/Ung Disease.— In all chronic 
diseases of the lungs the diet should be as easy of diges- 
tion and especially a diet which will not cause flatulence, 
as this pushes up the diaphragm and interferes with 
breathing. (See Diet in Diseases of the Heart.) 

Fuentnonia. — The diet in pneumonia is of the great- 
est importance. The patient's recovery often depends 
upon the matter of his being well nourished. 

The same genera! principles of feeding should be fol- 
lowed as arc indicated in all acute fevers, During the 
course of the the patient should receive an 
abundance of water in addition to the liquid food sup- 
plied. Plain water or any carbonated water that the 
patient may desire should be given. Milk and seltzer 
may be allowed freely. Lemonade or orangeade, or 
water flavored with tamarinds, may serve to lend variety. 
The " Imperial drink" (the recipe for which appears at 
-the end of this book) may also be given. 

During the height of the disease milk should form the 
basis of the diet. This may be peptonized or diluted 
with lime water. Albumin water, wine whey, malted 
milk, beef juice, Eskay's food, and .similar preparations 
may be employed when milk is not well borne. Prcdi- 
gested liquid beef preparations may be used both for 
their stimulating effects and as a food. They should 
always be diluted freely with water unless, because of 
vomiting, a concentrated food is indicated. 


Food should be given at regular intervals of from two 
to four hours, according to the patient's condition and 
the amount he is able to take at one time. 

Constipation, flatulence, and vomiting are to be avoided 
whenever possible. If they do occur, efforts should at 
once be made to relieve the condition. 

In most cases starches and sugars are best omitted 
from the diet. Fruit may be allowed at any time during 
the disease, and is of special benefit during convales- 
cence. Most grateful during the severe stage are orange 
juice, lemonade, grape-fruit, and grapes. During conva- 
lescence ripe peaches or pears in season may be added 
to the diet. The return to a general diet should be made 
gradually, and no solid food should be allowed until the 
fever has subsided. Then the general dietetic rules for 
convalescents may be followed. 

Alcohol is given only according to the directions of the 




General Directions for Diet. — The diet for patients 
with heart disease usually requires considerable atten- 
tion. In general there are two stages of heart disease. 
The first is called " the stage of compensation," when 
the heart, although diseased, is still able to pump the 
blood through the body. The second stage, or "stage 
of broken compensation," is when the, heart, no longer 
able to cope with its work, is unable to force the blood 
through the vessels as it should and there is a certain 
amount of damming back of the blood. This causes 
numerous unpleasant symptoms, such as edema, diffi- 
culty of breathing, and irritability. 

During the first stage the diet requires comparatively 
little attention beyond the observance of certain general 
rules. When the second stage is approaching the diet 
should be carefully supervised, for the patient may be 
spared much suffering, and often the time of the broken 
compensation postponed. 

The meals should be small; more should never be 
given than the patient can easily digest. If the stomach 
is overloaded the diaphragm is pushed up and displ; 
the heart, and this may occasion palpitation and dyspnea. 
If the meals are too large the residue of any 
food in the intestine may undergo fermentation and 

lisplaces ^H 

lyspnea. ^H 

digested ^H 

on and ^H 


caune flatulence, with its attendant disagreeable symp- . 

The meals should be simple and well cooked. Im- 
properly prepared food is a cause of indigestion, and 
may produce flatulence or discomfort. The food chosen 
should be of a kind that is easy of digestion. A suffi- 
ciently long interval should be allowed to elapse between 
meals, and eating between meals should be strictly pro- 
hibited, as even small portions of food taken when 
digestion is in progress may give rise to flatulence in 
these patients. 

The meals should all be of equal size; while the even- 
ing meal may be a little smaller and lighter than the 
others, and the principal meal should be taken at midday, 
there should, as has been said, be but comparatively 
little difference Tn their size, and the patient should be 
instructed carefully in this regard. 

The amount of fluid taken should not be too large, 
nor, on the other hand, should it be too small. When 
compensation has been lost, the question as to the 
amount of fluid to be taken becomes of much impor- 
tance. At no time should it be forgotten that fluids dis- 
tend the vessels, raise arterial tension, and increase the 
work of the heart. If the quantity of fluids given be 
too small, elimination is delayed and the irritative effect 
of the retained impurities in the blood proves harmful. 
Fluids should be taken between meals and are best 
sipped slowly. Weak tea and coffee may be allowed 
in small quantities between meals; if they do not 
flatulence, however, they may be allowed at meal times, 
but always in great moderation. 

Alcohol is best avoided. If, owing to the general 
weakness of the patient, its use is indicated, it should be 




given in small quantities, and in the form of pure whisky 
or brandy weil diluted. Wine and beer are contra- 

In general it may be said that a diet of plainly pre- 
pared food, unencumbered by too many restrictions, is 
best in these cases. 

All highly seasoned food and the condiments in gen- 
eral should be omitted from the diet, as they tend to 
stimulate the appetite of the patient and may cause him 
to take more food than is necessary or desirable. 

Stews and fancy dishes should also be omitted, as 
should the foods usually classed as difficult of digestion, 
such as fried foods and the like. 

Starches, sugars, and fats should, as a rule, be re- 
duced ; this restriction, however, should be enforced 
strictly only when made necessary by complicating 
stomach disorders coming on as compensation rupt- 
ures, when they are apt to cause fermentation and 

Broadbent dwells on the necessity for giving a diet 
containing about the usual proportion of food constitu- 
ents. Starches and vegetables are useful additions to the 
diet, as they help to keep it from being too largely nitrog- 
enous. If too much protein material is taken it is imper- 
fectly oxidized, and the waste accumulating in the blood 
increases the work of the heart, just as when too much 
food is taken. 

The diet should consist largely of milk and of dishes 
made from this food ; eggs, rare meats, especially mutton 
and beef; poultrj', fish, and oysters. Well-baked bread, 
rolls, or biscuits, which are never to be eaten warm, and 
cereals in moderate quantities may be allowed. Well- 
cooked potatoes, spinach, asparagus tips, cauliflower tops. 



and other similar vegetables may be taken, all stalks 
being avoided. 

The diet list should be simple and such as will not 
require complicated directions. 

As compensation becomes impaired, numerous disor- 
ders of digestion occur and require care and attention. 
The patient with heart disease may develop a distaste for 
food, and this will often tax the ingenuity of the physician. 

As blood-stasis sets in, constipation is apt to occur. 
Hypostatic congestion of the hvcr comes on, causing 
lessened metabolism, and consequently interfering greatly 
with the general nutrition. The stomach and intestine 
arc affected and a chronic catarrhal condition of both is 
generally present. 

The quantity of fluid given should now be regulated 
carefully, neither too much nor loo httle being given. A 
glassful of Vichy half an hour before eating will help to 
prepare the stomach for a meal, and will, as a rule, be 
excreted promptly. Fluid is absolutely necessary for 
metabolic changes, and may be taken in the form of the 
" Imperial drink," elsewhere described, between meals. 
A glassful of hot water flushes out the body, and as jt 
is rapidly excreted does not add materially to the amount 
of fluid present. 

In the Oertel treatment of heart disease the fluids 
are allowed only in a very limited degree. If the patient 
is on a milk diet, other fluids besides milk should be 
given in comparatively small quantities. 

If edema, is severe the food may be given in as concen- 
trated a form as possible. 

If flatulence is troublesome, fats, starches, and sugars. 
as well as beer, pastry, and stews, are to be avoided. No 
solid food should be taken between meals. Coffee or tea 



taken with the meals may give rise to flatulence. They 
may, however, in some cases be taken during the day, at 
a time when the stomach is empty; they should be 
freshly prepared and should never be strong. Only such 
quantities of food as the patient can digest should be 
allowed, and if necessary digestion may be aided by 
giving essence of pepsin or other digestives. In some 
cases a milk diet may become necessarj'. 

Sudden dilatation of the heart occurring during or fol- 
lowing any acute disease requires rest and a milk diet. 

Palpitation and dyspnea are often caused by the inges- 
tion of too abundant meals ; if persistent the food should 
be given in smaller quantities and at shorter mtervals. 
Four or five small instead of three large meals may be 
taken at regular intervals, or a milk diet may be ordered 
for a time. The general management may be such as 
has been suggested for flatulence. Tea, coffee, and 
tobacco should be avoided, and effervescing drinks may 
also be omitted. If there is constipation, stewed fruits, 
especially prunes or figs, are useful. 

Gastric disturbances are best met by rest and a milk 
diet for a time, with a gradual return to the ordinary diet 
or a diet such as is advised for cases of gastric catarrh. 
Much relief frequently follows the drinking of a glassful 
of hot water or of Vichy half an hour before a meal. 

A.I ruptured compensation is accompanied by effusion, 
something must be said with special reference to the re- 
moval of fluids from tiie body. Here, indeed, feeding is 
a difficult task, for the patient usually has a disgust for 
food. If the patient is very ill, nourishment may be 
administered every three hours. If he is able to be 
about, it will often be well to allow him to take his meals 
with the family at the regular meal time. He may be given 



chicken, tender meats, fish, oysters, and other forms of 
light food. When but little is taken at the regular meal ■ 
time, food may be given between the meals at regular 
periods, time being allowed for complete digestion to 
take place. Milk, albumin water, egg and milk, soup, or 
beef tea in small quantities are useful for this purpose, 
Broadbent recommends meat or ciiicken jelly or meat 
extracts for their stimulating efiect on the heart. Potted- 
meat sandwiches or meat pulp, prepared as directed for 
tuberculosis patients, may be given. 

Fluids other than milk and soups should be taken in 
as small quantities as possible, " Imperial drink " or hot 
water, as previously suggested, may be given to quench 
the thirst. 

Stimulants are usually needed, but should be given 
only under the supervision of the physician, as there is a 
tendency to take too much to relieve faintness or other 
symptoms. In non-alcoholics, from i to 2 oz. of whisky 
a day may be allowed at the beginning, the amount 
being increased as occasion demand.s. Stimulating drugs 
have largely superseded the use of alcohol in these cases. 

Aneurism ; Dilatation of the Blood-vessels. — 
Special diets are sometimes prescribed for these patients, 
Tufinel's diet, which restricts the foods to a very small 
quantity and enforces absolute rest, is the best known. 
Whether or not such diets should be used is a matter to 
be decided only by the most expert knowledge. 

Angina Pectoris. — Small ea.siiy digested meals are 
to be given according to the general rules for dieting 
heart disease. 

Anemia. — There are a number of different kinds of 
anemia, and the diet depends somewhat upon the form 
present. That following the loss of blood is usually 


rapidly recovered from. In this form infusions of salt 
solution are sometimes given. 

In general it may be stated that anemic persons require 
fresh air and sunshine and good food. Fresh food, milk, 
eggs, meats, green vegetables, and fresh fruits are the 
most important articles of diet The meals should be 
given at regular intervals and not too widely separated, 
usually about three hours apart. The meals should be 
small. Eating between meals should be absolutely pro- 
hibited, and this may require some watching, as the 
patient frequently has a very capricious appetite, eating 
all sorts of indigestible articles between meals and leaving 
the regular food untouched. The breakfast should be a 
good, nutritious one and consist of meat or eggs in addi- 
tion to other articles of food. Milk is valuable, but 
should not be given to the exclusion of other food. It 
is a good plan to have it taken toward the close of the 
meal, as otherwise the patient may spoil his appetite by 
drinking a glassful of milk at the beginning of the meal. 
Rest before and after meals is desirable. 




Urine and Food. — The urine bears a direct relation 
to the quality and quantity of food ingested, as well as 
to the quantity of fluid taken and the amount of work 
done by the individual. Many variations occur in the 
urine that are due to food or drink and that are normal. 
When the kidneys are diseased improper food may bring 
on dangerous or even fatal complications. 

One of the first principles of dieting persons with dis- 
eases of the kidneys is to avoid giving them food which 
is irritating to the kidneys. Among these may be men- 
tioned the browned outer surfaces of grills and roasts, 
strong sauces, spices, pastry, very acid foods, strong 
alcoholic drinks, and strong tea and coffee. Green vege- 
tables are to be avoided in acute diseases of the kidneys, 
as well as cranberries and fruits which contain kernels. 
As regards meats in the acute conditions, they are to be 
avoided until ordered by the physician. There is a popu- 
lar idea that the light meats are less injurious than the 
dark ones ; this has no foundation. Glands, such as 
liver, sweetbreads, kidneys, and spleen, should be avoided. 
Strong meat broths are also injurious. 

Alcohol is to be avoided in all cases except when 
prescribed by the attending physician. All alcoholic 
beverages are irritating to the diseased kidneys, and if 



anything they are more injuricjus in the chronic cases 
than in the acute. 

Water may be given freely in all cases where the urine 
is increased with the increase in the amount of water 
taken. It aids in the elimination of waste products. 
When, however, the amount of urine is greatly dimin- 
ished or none at all is passed, the physician should regu- 
late the amount of fluid that is given the patient, as there 
may be danger in giving too much. 

Acute Inflammation of the Kidney ; Nephritis. 
— During the first stage of the acute condition in the 
severer cases food is given in very small quantities, a pint 
of milk a day. To relieve the tliirst. tablespoonful doses 
of water may be given or pieces of ice may be placed 
in the mouth. In this stage the physician frequently pre- 
scribes some form of alcoholic stimulant. 

In the less severe cases a strict milk diet is followed, 
or, what is generally preferred, I \ quarts of milk is given 
with about \ pint of cream. Rice, groats, cornmeal por- 
ridge, crackers, and zwieback may be added if the patient 
has any appetite, and butter, sugar, and grape juice or 
other fruit juices may be given. Plain or carbonated 
waters, the " Imperial drink," weak lemonade, buttermilk, 
and similar drinks may be given. As convalescence 
advances calves '-foot jelly and similar preparations 
are allowable. Light vegetables may be added to the 
diet; spinach is perhaps the best, but cauliflower tops, 
young peas, or young string-beans may be used. In 
acute cases and their convalescence the patient's appe- 
tite is a fairly good guide as to the amount of food to be 
taken. Meat and eggs arc to be added to the dietary last 
of all. For a long time after an attack of inflammation 




of the kidneys the patient should avoid the articles of 
food which are irritating to the kidneys. 

Chronic Inflammation of the Kidneys. — In this 
disease the diet should be very much like that suggested 
for old ])eople. (See Diet for the Aged.) Alcohol is to 
be avoided, as are tea and coffee and all the foods set 
down as irritating to the kidneys. The amount of fluid 
taken should not be excessive. There is a popular idea 
that in this disease the more fluid one takes the better; 
this i.s not true, and in some cases excessive amounts of 
fluids are distinctly injurious. An occasional drinking- 
day or drinking-week is sometimes allowed, during which 
the patient drinks large quantities of water to flush out 
the system. This is frequently accomplished by an occa- 
sional visit to a watering-place, where the change of 
scene is often of as much value as the waters., 
fresh air, freedom from care and worry, suitable occupation, 
and pleasant surroundings are all important. A change 
of air to a dry, warm climate is often of great benefit. 

Another point to remember is that many drugs are in- 
jurious to the kidneys, and the taking of indiscriminate 
headache powders and other things without a knowledge 
of what they do or of what they contain is a habit which, 
if for no other reason than protecting the kidneys, i.s to 
be most highly condemned. 

Movable and Floating Kidney. — This trouble is 
sometimes seen after rapid loss of flesh from any cause. 
A rest or careful feeding to regain the original weight is 
in many cases of great service. 

Calculous Affections. — The tendency to stone for- 
mation, as in the kidney or bladder, and the much-talked- 
of condition usually called the uric acid diathesis, may 
be considered together. 



In many instances, but by no means all, too rich food, 
too lai^e meals, and too little exercise are at the bottom 
of the trouble. 

The following suggestions regarding the diet will be 
found useful: Avoid strong drinks, and all alcohol if 
possible; much meat, and especially the nuclein-contain- 
ing -meats, as thymus, spleen, liver, brain, caviare, etc., 
smoked, pickled and spiced meats, and rich foods in 
general. The fats and sugars as well as the cereals 
should be restricted. The diet should be made up of the 
plainer, well-prepared foods, and so far as possible a 
vegetable diet should be prescribed. Water, especially 
the alkaline mineral waters, may be allowed in abun- 
dance. A sojourn at Carlsbad may be recommended 
for certain ebese patients. 

Mineral waters must be used with extreme caution, for 
if too much alkaline water be taken it may increase the 
deposit of certain earthy .salts. The physician should 
direct the kind and amount of such waters as are to be 

The directions for diet are very simple. All irritating 
foods and drinks should be avoided, as should all indi- 
.gestible articles. The diet should consist of plain and 
wholesome food. Where it is possible, skim-milk should 
form the basis of the diet. Too much meat should not 
be taken, and twice -cooked meats and fried and very 
greasy foods avoided so far as possible. Carbohydrates, 
as breadstuffs, cereals, and the non-acid vegetables, may 
be allowed. Care should be taken to avoid all com- 
plicated and highly seasoned foods, all pepper, spices. 


and salad dressing. In a word, everything previously 
mentioned as irritating to the genito-urinary tract should 
be avoided. Acid fruits, asparagus, and tomatoes are 
also to be forbidden. Tea and coffee should be pro- 
hibited or given very weak and well diluted with milk or 
cream. All alcoholic drinks should be forbidden. 



The necessity for the correct management of the diet 
in nervous diseases is becoming appreciated more and 
more every year. As a general rule, it may be stated 
that all functional diseases attended with emaciation are 
greatly benefited, if not entirely relieved, by merely in- 
creasing the patient's weight by such methods as are 
suggested under the heading of Rest Cure. Patients 
with chronic lesions will, as a rule, be made more com- 
fortable if the following two points are borne in mind: 
First, to overcome, so far as possible, emaciation and 
anemia where the nutrition has a tendency to be below 
normal; and secondly, and of no less importance, to 
prevent undue obesity In those so inclined, particularly 
where there is disturbance of locomotion. A patient 
may be condemned to remain in bed or in a chair on 
account of the excessive weight which his inactivity has 

Most patients regard diet as a very unimportant part 
of the treatment; this is especially true of those cases 
that most need careful feeding. The necessity for careful 
dietary should be impressed upon these patients, and a 
faith in its efficacy engendered where the disease is of a 
functional nature. 

The diet suitable in nervous diseases has been the 


subject of many diverse opinions, particularly in the 
minds of the laity. Fish has been vaunted as a " brain 
food," and various fats or cereals have been suggested 
for nervous conditions. At the present time, it may be 
stated, there is no specific "nerve food." The nutrition 
of the nervous system will be good when the patient's 
general nutrition is good, and vice versa. Both in func- 
tional disorders of the nervous system and in the psy- 
.choses dependent upon exhaustion the improvement of 
the general condition should be the first care. 

The basis of the diet is usually miik. Care should be 
taken to see that the patient gets sufficient fluid, and 
where no tendency to obesity exists water should be 
taken with each meal, and usually at bedtime and on 
rising. It may also be taken between meals if desired. 
When there is disturbance of digestion, it is a good plan 
to prepare the stomach for the meal by sipping a glassful 
of hot water on rising and an hour or less before each 
meal. The mineral waters may be used when desired; 
the alkaline ones are apt to be of most value. Carbon- 
ated waters should be used with care, lest the flatulence 
they may cause give rise to symptoms the importance of 
which may be greatly exaggerated by the patient. 

A question of great importance is whether or not 
alcohol should be used. As a general rule, it should not 
be allowed. In cases with chronic lesions, where the 
patient has been accustomed to the use of alcohol all his 
life, it may be allowed if not otherwise contra-indicated, 
as in a tendency to cerebral hemorrhage, arteriosclero.sis, 
chronic interstitial nephritis, and the like. The use of 
alcohol in the functional disorders is usually contra- 
indicated. Its value as a food and as a stimulant to 
nutrition should not be overlooked, and it may be used 



with great benefit in the psychoses accompanied by ex- 
haustive conditions. 


Some cases of neuralgia are directly caused by indis- 
cretions ill diet ; other cases depend on a lowered state 
of nutrition, while still others may be due to plethoric 
states. Neuralgia is also caused by many factors not 
related to the diet of the patient. To decide this ques- 
tion requires great experience and judgment on the part 
of a skilled physician. 

As a general rule, plain, wholesome food should be 
ordered at regular intervals. The patient should not be 
allowed to eat between meals. Ail rich, complex, and 
highly seasoned foods should be forbidden, as should all 
fried foods, pastry, and anything known to disagree with 
the patient. Care should, however, be taken that the 
diet be not restricted, for tiie patient's ability to take dif- 
ferent articles is often purely imaginary. True idiosyn- 
crasies for different articles of food are not very common. 
The excessive use of tobacco may be the cause of 


When not dependent upon other conditions, these are 
apt to be due either to eating at night or to a depressed 
state of the nutrition. For the first there is nothing to 
do but to discontinue the habit of eating at night. There 
arc but few persons who reach middle age and can 
eat late at night with impunity, and sooner or later the 
individual learns that he must give up the habit. There 
are some, however, with whom the practice seems to 


When the trouble is caused by malnutrition or anemia, 
the general condition of the patient must be treated. 
Good food, regular hours, milk or some light food be- 
tween meals, and on going to bed a cupful of hot milk, 
cocoa, or, if preferred, beef tea, malted milk or similar 
preparation may be ordered. 

In many cases where the nutrition is fairly good one 
of the hot drinks just mentioned taken at bedtime may 
be all that is necessary. This is especially true of the 
insomnia and disturbed sleep that follow the doing of 
mental work at night. The effect is to dilate the abdom- 
inal vessels and to restore the equilibrium of the circu- 
lation. A brisk walk in the open air or five minutes* 
exercise will often accomplish similar results. 


Epilepsy bears an important relation to diet. There is 
no specific " anti-epilepsy " diet, and there is no form of 
food that can be assigned as a cause of epilepsy ; it is, 
however, a fact that where the diet is carefully regulated, 
the number of attacks are usually lessened. This is par- 
ticularly true of children. The principle involved is to 
give only as much food as the patient can easily digest 
and assimilate, and to allow sufficient time to elapse 
between feedings for him to utilize and excrete the end- 
products of what he does assimilate. When this is not 
done, attacks may be provoked by irritating substances in 
the bowel, by the absorption of toxic substances from the 
intestinal tract, or by the accumulation of the products 
of metabolism in the body. In the epileptic colonies no 
especial diet is used, but the amount and the variety of 
food are so regulated as to secure the best results. 


In children a diet composed largely of milk, with the 
addition of cereals and fruit, is most useful. In older 
persons this diet is not feasible except occasionally as a 
temporary measure. For these latter meat should be 
allowed only once a day, unless on account of excessive 
manual labor or because of a weakened condition of nutri- 
tion the patient especially demands it. Milk, cereals, 
bread, vegetables, and fruit should make up the rest of 
the dietaiy. JKach patient should be instructed to take 
only digestible food, to take his meals regularly, and not 
to eat too much. They should also be taught to eat 
slowly and masticate the food well. The avoidance of 
constipation is of primary importance, and this can usually 
be secured by the proper use of fruits and the coarser 
forms of cereals. 

Quiet, open-air life, pleasant occupation of a non- 
strenuous kind, an absence of worry, and agreeable 
forms of recreation are just as important as the diet in 
these cases. 


In chorea the diet is often of the greatest importance ; 
this is especially true when it occurs in anemic or debili- 
tated children. Rest and an easily assimilable diet are 
the indications. The authors are of the opinion that 
absolute rest in bed, if possible isolated from the remain- 
der of the family and under the care of a trained nurse, 
who should be a stranger, combined with a milk diet or 
a diet composed largely of milk, will give better and more 
lasting results than any other form of treatment. If the 
patient is anemic, beef juice made from fresh beef may be 
used to advantage, as well as raw scraped beef and simi- 
lar foods. 




Comatose Stage. — During the early stage of the 

comatose condition — /. c, for the first day or two — there 
is, as a rule, no necessity for giving the patient any food. 
As the disease is most likely to occur in obese, overfed 
individuals, the abstinence from food is often beneficial. 
The intestinal tract should be flushed out as soon after 
the patient is seen as is practicable. Those about the 
patient should be instructed carefully as to the dangers 
of attempting to feed the patient if he is unable to swal- 
low, for he may, on the one hand, choke, and, on the 
other, he may draw food or drink into his lungs during 
inspiration, and so set up a pneumonia. 

If the patient is in need of nourishment or of fluid, it 
may be given by the rectum. Normal salt solution may 
be given by the rectum to supply the body with fluid, but 
it should not be given in too large quantities. (See Rec- 
tal Feeding.) 

I,ater Stages. — As soon as the patient recovers suffi- 
ciently to be able to swallow without danger of inspir- 
ing the food he may be fed by the mouth. The food 
should be liquid or semi-solid, and of a bland, unstim- 
ulatiny character. The quantity should not be too large. 
Milk, milk and eggs beaten together in the form of a 
milk punch, without, however, the addition of a stimu- 
lant ; broths, soft eggs, and milk thickened with cereals, 
or the purees of vegetables may be used. As the patient 
improves other food may be added, but the diet should 
be light, easily digestible, and as non-.stimulating as pos- 
sible. The patient should be warned against overeating 
and also against drinking. Alcohol is allowable only in 
the case of habitues wlio are threatened with collapse 

unless it is used, or iii the same class where food is not 
assimilated without it It should always be given in 
moderate amounts, and the dosage arranged by the phy- 
sician, and never left to the nurse, the patient or the 

On account of the lack of exercise the diet should 
contain but httle meat, but cereals, vegetables, and fruit 
should be given in small quantities at a time, and as 
evenly distributed throughout the day as possible, to 
avoid overfilling of the vessels. 

The greatest danger, from a dietary standpoint, is in 
those patients who recover sufficiently to rettini to their 
ordinary modes of living. They should be very care- 
fully instructed neither to drink to excess nor to overeat. 
A full meal and several drinks may be the cause of a 
second or of a fatal attack. 


The mild forms of alcoholism are usually easily man- 
aged. So long as the stomach is irritable it should be 
given absolute rest If possible, alcohol should be with- 
held entirely. As soon as the stomach will retain fluid 
a saline mineral water or a saline purge should be given. 
Milk or bouillon is next to be prescribed, and as the 
desire for food returns a light diet of soft-boiled eggs, 
milk toast and the like should be allowed. After re- 
covery all rich and highly seasoned food should be 
avoided, particularly the spices and peppers, which are 
commonly used to excess. 

In the severe forms the diet should be that recom- 
mended for chronic gastritis. Some confirmed alcoholics 
can retain nothing in the stomach until they have had their 
morning drink. When nutrition is threatened this may 

^^^k inten 


be allowed, but it is apt to lead to exces.scs later in tlic 

In the very severe forms, as in delirium tremens 
or in cases approaching it, the patient should take as 
much fluid as possible to flush out the system, and the 
intestinal tract should be thoroughly purged. The food 
should be given in a predigestcd or in a partially predi- 
gcstcd form and at frequent intervals. In this way the 
craving for drink is somewhat alleviated. Bouillon or beef 
tea to which considerable amounts of black pcp|ier or 
even Cayenne pepper have been added is useful in this 
condition, although their use would be contra-indicated 
for any but an alcohol -saturated person. Rest and sur- 
alimentation as soon as food can be borne constitute the 
best method of managing these cases. Strychnin may be 
used as a .stimulant. 

Illness or Injtiry in Alcoholics. — When a man 
who has been accu.stomed to taking several glasses of 
spirits every day for years is suddenly stricken ill or 
injured, delirium will often develop if the stimulant is 
rapidly withdrawn. In alt such cases the accustomed 
amount of alcohol should be given, care being taken, 
however, to prevent overindulgence. 

In alcoholics affected with pneumonia alcohol is neces- 
sary to sustain life. When dehrium occurs in the course 
of pneumonia alcohol should be ordered, although in 
ordinary-, uncomplicated cases of delirium tremens due 
to extreme overindulgence it should be withheld. 


The technic of the treatment is explained in a most 
interesting way by Mitchell, in his book " Fat and Blood." 


The more nearly perfect the technic and the more closely 
it is adhered to, the more likely is cure to follow. The 
cases are of various grades of severity, and the treat- 
ment is modified to suit the individual. Isolation is 
necessary, and the patient should be removed to a hos- 
pital or a sanitarium, away from familiar scenes. Home 
treatment does not succeed well. If circumstances com- 
pel the patient to remain at home, her room should be 
changed. In severe cases with emotional manifestations 
visiting is forbidden, but it may be allowed to a " certain 
extent when the patient is anemic owing to a distinct 
cause, as overwork, blood-, dyspepsia, low fevers, 
or nursing." The should be a stranger to the 

Communication with friends and family should, as a 
rule, be cut off entirely, and not even the reading of 
letters .should be allowed. After several weeks, if the 
patient is improving, she may be allowed to read the 
newspaper each day. 

Rest is a most important feature, and, as a rule, the 
patient should be put to bed for .six weeks or two months. 

In other cases, especially where the patient is not able 
to undergo regular treatment, as in dispensary cases, a 
modified rest cure may be tried. The following is 
Mitchell's schedule for such cases ; this may be modified 
according to circumstances : 

" 7.30 A. H. : Cocoa, coffee, hot milk, beef extract, or 
hot water. Rath (temperature stated). Rough rub with 
towel or flesh-bru,sh. Bathing and rubbing may be done 
by attendant. Lie down a few minutes after finishing. 

"8.30 A. M. : Breakfast in bed. {Detail as to diet. 
Tonic, aperient, malt extract as ordered.) May read 
letters, papers, etc., if eyes are good. 


" 10 to 1 1 A. M. ; Massage, if required, is usually ordered 
one hour after breakfast, or Swedish movements are given 
at that time. An hour's rest follows massage. I^ss 
rest is needed after the movements. {Milk or broth 
after massage.) 

" 12 M. : Rise and dress slowly. If the gymnastics or 
massage are not ordered, may rise earlier. May see 
visitors, attend to household affairs, or walk out. 

" 1.30 P. M. : Luncheon. (Malt, tonic, etc., as ordered.) 
In invalids this should be the chief meal of the day. 
Rest, lying down, not in bed, for an hour after. 

" 3 p. M. : Drive (use street cars or walk) one to two 
and one-half hours. (Milk or soup on return.) 

" 7 p, M. : Supper, (Malt, tonic, etc., as ordered ; detail 
of diet.) 

" 10 K M. : Hot milk or other food at bedtime." 

In extreme cases the patient is made to rest absolutely. 
No exertion of any kind is to be allowed. The bed-pan 
is to be used with the patient in the recumbent position. 
She should be removed to a couch for an hour, both 
morning and evening, while the bed is being freshened. 
Tlie patient should be fed, and later, when allowed to 
feed herself the meat should be cut up for her. A sponge- 
bath should be given daily, but if it causes depression it 
may be given less frequently. After two weeks, if the 
piiysician thinks it desirable, the patient may be read to 
for one to three hours. The monotony of the treatment 
is not so trying as would be imagined, for the routine of 
the day occupies most of the time. The nurse and ma.s- 
seuse should not talk about or listen to the patient's ills, 
and the latter should be taught that she .speak of 
them only to the physician. 

Massage and electricity arc resorted to in order to 


Diet in diseases of the nervous system. 247 

maintain nutrition and circulation while at rest. Mitchell 
gives minute instructions regarding both. General mas- 
sage of the whole body is to be given, care being taken 
not to excite pain by manipulating tender areas. The 
tapping movements, slapping, and the like are not to be 
used in nervous patients. Care should be exercised to 
avoid producing sexual excitement ; this may be aroused 
in both sane and insane patients from friction near the 
genitals or over the back or buttocks. If it does occur, 
the operator should avoid the sensitive areas. In the 
average case massage should be given for an hour daily 
for about six weeks, and then on each alternate day. 
The time chosen for this should be about midway be- 
tween meals. Care should be taken to keep the parts 
warmed by the massage well covered. 

The same precautions should be taken in using elec- 
tricity as when giving massage. The induced current 
should be used, and it is well to employ a battery in 
which the breaks are very .slow — from two to five 
second.s. The more rapid interruptions are useful, how- 
ever, but in the hands of an unskilled operator may 
excite pain and apprehension in the patient. TJie poles 
may be placed 4 or 5 m apart on the muscle, and the 
whole body should be gone o\er 

In thin, anemic, exhausted women, who arc the ones 
usually treated, the diet is as follows : The patient is put 
to bed and the diet generally changed from the ordinary 
to a milk diet. This is done by gi\'ing from 3 to 4 oz. 
of milk every two hours, after the Karell method. Then 
the patient is given 2 quarts of milk in each twenty-four 
hours. The amount is divided and a portion given at 
three-hour intervals. At the end of the first week a 
pound of beef is administered in the form of a raw soup. 


This is given three times a day, a pound of beef being 
used each day. If desired, this may be replaced by pep- 
tonized food. (See formulas in the Appendix.) 

After ten days three meals a day are given. These 
are led up to gradually, and the patient is kept on the 
milk diet until the stomach feels comfortable. Then, 
usually within from four days to a week, a light breakfast 
is allowed, and in a few days more a chop is given at the 
midday meal. After a short time the patient is given 
three full meals, together with 3 or 4 pints of milk instead 
of water, either with or after the meals. 

After about ten days of this treatment, from 2 to 4 oz. 
of good fluid extract of malt are given before each meal. 
"As to meals, I leave them to the patient's caprice, 
unless this is too unreasonable ; but I like to give butter 
largely, and have little trouble in having this most whole- 
some of fats taken in large amounts. A cup of cocoa or 
of coffee and milk on waking in the morning is a good 
prescription for the fatigue of the toilet." 

In some of the difficult cases \ oz. of cod-liver oil is 
given half an hour after each meal. If it causes nausea 
or interferes with the appetite, it is given as a rectal 
injection. This is of particular service where the bowels 
are sluggish. It may also be given in the form of an 
emulsion with pancreas extract. In some it acts admira- 
bly; in others it may cause tenesmus. 


Until otherwise ordered, absolute rest in bed. No 
visitors, no reading, and no conversation with nurse on 
the subject of disease or treatment. 

First Day. — One quart of milk in divided doses every 


two hours. 8 A. M. : Cold bath followed by a brisk rub. 
If patient does not react well, a warm bath may be used 
for several days and then the cold bath tried again, 
II A.M, : Twenty minutes" massage. 2.30 P.m.: Room 
darkened far a nap. 4 p. m. : Twenty minutes' electricity. 
9 p. M.: Brisk rub over the entire body. 

Second Day. — Same as first. Milk \\ quarts; massage 
and electricity increased to forty minutes. 

Third Day. — Two quarts of milk in divided doses at 
three-hour intervals ; massage and electricity one hour 

Fourth Day. — Same, with addition of white of a raw 
egg with each glassful of milk; cupful of cocoa on 

Fifth Day. — Same, with addition of raw-beef soup or 
broth, I pint in two portions ; a slice of toast. 

Ninth Day.— Same, with soft-boiled eggs and toast for 

Tenth Day.^Cocoa on awakening. 7.30 a.m.: Bath 
and brisk rub. 8.30 a. m. : Breakfast, including cereal, 
chop or eggs, bread and butter, and 2 glassfuls of milk 
with the whites of 2 eggs. 10 to 11 a.m.: Massage. 
11,30 A.M.: Half-pint of milk, whites of 1 or 2 eggs. 
2 p. M.: Full dinner, including 2 glassfuls of milk and 
whites of 2 eggs. 3.30 to 4 p. m. : Electricity. 5 p. m. : 
Glassful of milk with whites of 3 eggs. 7.30 p. m.: 
Supper including milk and eggs, g.30 p, m.: Brisk rub 
and a glassful of milk. 

Schedule as above until desired effect is obtained. 
This to be modified to suit the individual case. On 
twelfth day 2 oz. of malt extract with a teaspoonful of 
solution of peptonate of iron and manganese, or a table- 
spoonful of Gude's Feptomangan is usually ordered. 


Bowels to be kept open. Use butter in as lai^e quan- 
tities as possible. 

The patient is allowed to undertake movements for 
herself very gradually, being aJlowed to move about in 
bed by herself and then sit up, and later on to sit out- 
doors and then to walk a few steps, to take a drive, etc. 
If this is not done gradually the moving about may be 
attended by dizziness, vertigo, or unpleasant exhaustion, 
which may be avoided entirely by gradually increasing 
the patient's efforts for herself 


Feeding constitutes a very important part of the treat- 
ment of the insane. All insane persons who are below 
the standard of nutrition should be built up and an earn- 
est effort made to increase the weight of the patient. One 
of tlie Knglish alienists was wont to talk of the " gospe! of 
fatness." This is best accomplished by a system of feed- 
ing somewhat similar to that outlined in the rest treat- 
ment, the rest being prescribed or omitted as the case 
demands. It .should always be remembered that an in- 
sane person may contract otiier diseases besides his 
mental disorder; tliis is true especially of stomach and 
intestinal disorders, which may give to delusions 
regarding the taking of food. 

When the patient refuses food, the question as to the 
advisability of feeding him by force arises. Kver^'thing 
considered, it is well to begin the forced feeding early, 
before the patient has time to suffer from his fa-sting. It 
should be accomplished by means of the stomach tube 
or the na.sal tube, and about a liter (1 quart) of food 
should be introduced. The food may be given thus 
twice daily, and in the case of weak patients three or four 



times a day. Milk, milk and eggs, and broths may be 
used for this purpose, A sufficient number of attend- 
ants should be at hand to control the patient if he be- 
comes unruly and resists feeding. After a patient has 
been fed with the tube several times he will often prefer 
to take his nourishment in the usual manner. 

Whether the esophageal or the nasal tube is to be used 
wit! depend on the preference of the physician. Kach 
has its advantages. The nasal tube is generally pre- 
ferred, since it is easier to introduce, can not be bitten by 
the patient, and does not cause the patient to struggle as 
much as the stomach tube ; it may, however, be passed 
into the larynx, and in this way liquid might be intro- 
duced into the trachea. This danger i.s more fancied than 
real, and can be avoided if the patient is allowed to 
breathe before the fluid is poured into the tube. While 
he is breathing the tube should be pinched, and if it is in 
the larynx this fact will be noticed at once. Ordinarily, 
but not always, coughing ensues; it does not follow 
when the pharj'nx is anesthetic, as it occasionally is in 
the in.sane or hysteric. The stomach tube does not allow 
the food to be regui^itated so easily as the nasal tube, but 
for this method of feeding a mouth-gag is required, which 
may injure the mouth or teeth, or it may slip, permitting 
the patient to bite the tube. If the patient has acquired 
the knack of regm^tating the food, this may be pre- 
vented by tickling the ribs while the fluid is being intro- 
duced. This prevents the fixing of the diaphragm, and 
is successful in most cases. 

Tact and experience in handling the insane arc of the 
greatest value. Some nurses or attendant."; have little 
difficulty in getting patients to eat, whereas others seem 
never to learn how to manage them. It must be remem- 




bercd than an insane patient may not eat for reasons that 
arc often easily overcome. He may prefer to take his 
food alone, because he does not think himself worthy of 
eating at the same table with other people. He may fear 
that his food has been poisoned, and he should be con- 
vinced of the fallacy of this by the nurse, who should 
cat a portion before him or allow him to .see the food pre- 
pared, or he may be given food that can not easily be 
poisoned, such as eggs, whole vegetables, and fruit 
When the patient's confidence is gained the battle is gen- 
erally won. In some cases the delusion persists for a 
long lime and can not be dispelled. 

Food should alwaj's be ser\ed daintily. An insane 
person who may be verj' much unbalanced may still no- 
tice the slightest variations in the way of serving food. 
Attendants are apt to be negligent in thi'^ respect. For 
all patients who have a suicidal tendency the food should 
be served on dishes that can not be broken. No knives 
should be allowed, and the food should be served so as 
to require no cutting. An attendant should watch those 
who are apt to bolt their food and see that it is cut into 
small pieces before serving it. Cases of sudden death 
have followed the drawing of a piece of meat into the 
larynx while eating too rapidly. 



I ply 



Thj.s is one of the diseases in which the diet is of pri- 
mary importance and, in fact, the principal part of the 
treatment. No one but a skilled physician should ever 
attempt to regulate the feeding of a diabetic patient, as 
the well-being, and usually even life itself, are directly 
dependent upon the diet. The outlook in the disease is 
in many cases gloomy enough with the greatest possible 
care, whereas in poorly managed cases it is made much 
more so. Many complications, causing great suffering 
on the part of the patient, are the direct result of errors 
in diet. 

In order to carry out intelligently the physician's or- 
ders, the nurse should understand the principles of the 
diet to be followed. Diabetes is a disease in which the 
capacity to burn up sugar as food is depressed. The 
sugar taken is to a great extent passed oft" from the body 
in the urine. Not every person who has sugar in the 
urine is a diabetic. 

The chief indications in the management of diabetes 
are to maintain the patient's strength, to increase the 
sugar- destroying power of the body, and to avoid com- 
plications. These results are accompli.shed by sup- 
plying a sufficient amount of food in such a form that 


it may be utilized by the patient, and by avoiding car- 

The sugar which is passed in the urine has not been 
used as food, and this amount must be taken up in the 
other food elements or the patient will lose weight. If 
too much carbohydrate food is taken continuously, the 
patients nearly always do badly and develop complica- 

The physician in prescribing the diet has in mind three 
things : the amount of sugar that the patient is excreting 
daily, the gain or loss of weight, and the general condi- 
tion of the patient. There are other factors which may 
influence his choice of diet, but these are very technical 

From time to time the physician may desire to see how 
much sugar the patient passes when taking a diet free 
from carbohydrates. For this purpose the patient is 
ordered a diet somewhat like the following: 

Von Noorden's Carbohydrate-free Diet. — Break- 

fast : 5 gm. of tea steeped in 200 c.c. of water ; 1 50 gm. 
of ham ; i egg. 

Luncheon : 200^mi. cold roast beef; 60 gm. fresh cucum- 
bers with 5 gm. vinegar; 10 gm. olive oil, and salt and 
pepper to taste ; 20 c.c. brandy with 400 c.c. Apollinaris 
water; 60 c.c. coffee without milk or sugar. 

Dinner : 200 c.c. clear bouillon ; 250 gm. beef (weighed 
raw) basted with 10 gm. butter ; 80 gm. green salad with 
10 gm. vinegar and 20 gm. olive oil, or 3 tablespoonfuls 
of some well-cooked green vegetable ; 3 sardines in oil ; 
20 c.c. cognac with 400 c.c. Apollinaris water. 

Supper : 2 eggs (raw or cooked) ; 400 c.c. seltzer water. 

The patient is not put upon this diet suddenly, but the 
carbohydrates are reduced gradually. This diet is gen- 


erally used for five days, during which time the condition 
of tlic patient's urine is investigated by the physician. 

Prophylactic Diet. — Diabetes sometimes occurs in 
certain families, and members of such families are fre- 
quently ordered to limit the amount of carbohydrate 
food, especially about the age at which they have a ten- 
dency to take on flesh. 

Dietetic Treatment. — Mild cases in old people are 
generally given a diet restricted in a more or less general 
way. Foods consisting entirely or nearly so of sugar 
are forbidden, as well as dishes made largely from flour. 
Bread and potatoes are allowed according to the desire 
of the patient, and also any vegetables that may be served. 
When this form of diet is not sufficient the physician may 
order more restrictions. If the paticiit is thin the nurse 
must see to it that he takes the amount of food prescribed. 
In young persons even mild cases require close attention, 
and sugar may be withdrawn altogether and the food 
sweetened with certain drugs, as saccharin, saxin, garan- 
tose, dulcin, and the like. These are usually ordered in 
the form of tablets, each one representing the sweetening 
power of an ordinary piece of cut lump sugar. The 
patient is limited as to the amount of starchy food that is 
permitted, and is urged to take milk, cream, and fatty 

Severe cases require most careful attention. The diet 
is very strict, and for certain periods each year the patient 
is put upon a carbohydrate- free diet. It is difficult to get 
the patient to take sufficient nourishment, and the nurse 
must prepare as palatable dishes as possible from the 
list of permitted foods. (A number of recipes will be 
found in the Appendix.) The patient has a great craving 
for sweets and bread, coupled with an enormous appetite 



and great thirst, and considerable vigilance is often re- 
quired to see that he does not partake of forbidden food. 

Certain diabetic " cures " are sometimes prescribed as 
a diet composed largely of oatmeal or of potatoes or of 
rice. In certain cases a diet largely restricted to one or 
other of these foods may raise the patient's capability to 
burn up other forms of carbohydrate. 

Diabetic Coma. — The patient may become drowsy, 
complain of feeling numb, and then pass into a condition 
of unconsciousness. This is a very dangerous condition, 
and usually the patient dies. Certain changes in the 
urine may warn the physician that there is danger of 
coma, and when these changes are noted a more liberal 
diet is allowed. This extra diet increases the amount of 
urine passed and may flush out with it the poisonous 
materials from the blood. When coma occurs alcohol is 
given, and salt solution and sometimes solutions of grape 
sugar are given subcutaneously to increase the flow of 

Diabetes is frequently complicated with other diseases, 
as obesity, gout, or disease of the kidneys, which render 
the problem of the diet extremely difficult. 

Substitutes for Bread. — "Torrifled Bread." — Thin 
slices of bread arc toasted until very dark brown or almost 
black. It is supposed that the starch and gluten are 
partially decomposed by the heat. This will almost cer- 
tainly not be eaten to excess by the patient, and William- 
son states that this is probably its only advantage. 

Olntes bread, introduced over fifty years ago by Bou- 
chardat, has always been popular in France. This bread 
is made from gluten flour from which the starch has been 
washed out. The gluten flours on the market differ very 
much in the amount of starch which they contain. 


Directions for making gluten bread accompany the 
packages of flour. 

Bran bread, madt; from bran flour, is also to be recom- 
mended. The bran must be ground quite fine or it will 
not be digested. 

Soya biscuitH or bread are made from Soya bean, a 
Japanese product Soya bread was suggested for dia- 
betics by Dujardin-Beaumotz, in 1890. 

Almond cakes and cocoanut cakes are of considerable 
value as bread sub.stitutcs. 

Aleuronat is a vegetable albumin flour made by Dr. 
Hundhausen from wheat. It is a light-yellowish powder, 
and contains from So to 90 per cent, of albumin and only 
7 per cent, of carbohydrate. It was recommended in 
diabetes by libstein, who suggests that it be mixed with 
wheat flour. His formula contains considerable starch — 
i. e., about one-half the amount of ordinary bread — ^and 
most patients prefer to have half the quantity of wheat 
bread to a double allowance of aleuronat bread. 

The nurse may find it both interesting and instructive 
to study the tables given below, and the diet for such 
cases as the physician leaves with general orders may be 
arranged from them. Under no other circumstances 
should a nurse or other unqualified person attempt to 
manage the diet of a diabetic, and the physician should 
alway.s keep in close touch with the case. The nurse 
will be in a position to sympathize with the patient and 
to take extra pains with the details of carrying out what- 
ever may be ordered if she will try living on a carbohy- 
drate free diet for a few days. She will learn many 
things in that way which may not otherwise occur to her. 

The following four tables are taken from von Noor- 
den's article in The Twentieth Century Practice of Medicine : 



First Group. — UnconditioiuiHy AllowahU Foods. 

deer, wilii and don 

ic birds- 


n gravy i 

r with n 
tal parts of a. 


s : I'ungue, hearl, brai n, swecLbrcads, kid- 
with non- farinaceous sauces, 

J'resinvJ me,its: DrLed'or smoked meal, smoked or suUed tongue, 
haiD, smoked breast of goose, American canned meats, Australian corned 
beef. . 

Frtsh jisk : All kinds of fresh fish, boiled or broiled, preptared with- 
out bread crumbs or cracker meal, and served with any kind of non-fari- 
naceous sauce, preferably melted butter. 

I'risen'ed fish : Dried fish, salted ot smoked fish, such as codfish, 
haddock, herring, mackerel, flounder, salmon, sardellen, sprats, eels, 
lampreys, etc.; tinned fish, such as sardines in oil, anchovies, etc. 

Fiih deriualriia : Caviare, cod-liver oil. 

SheU-fisk : Oysters, mussels, and other bivalves, lobster, crawfish, 
crabs, shrimps, turtle. 

Altai extracls : Meal peptones of all kinds. 

Eggs : Raw or cooked in any way, but without any admixture of flour. 

Eats of all kinds, animal or vegetable. 

FrfiA vtgttables : Green leltnce, endive, cress, spinach, cucumbers, 
onion, leek, asparagus, cauliflower, red and white cabbage, sorrel, French 
beans. The vegetables, so far as Ihey ere suited to this mode of prepa- 
ration, are best cooked with meal broth or a solution of l.iebig's extract 
and salt, and covered plenlifully with buller, lard, suet, or goose faL 
The addition of flour is not permissible. 

Presri-vcd vrgctablis : Tinned asparagus, French beans, pickled cucum- 
bers in brine or vinegar, mined pickles, sauer kraut, olives. 

Spices: Sail, white or black pepper, Cayenne pepper, curry, cinna- 
mon, cloves, nutmeg, English mustard, anise seed, caraway seed, pars- 
ley, dill, borage, pimpernel, laurel, capers, chives, garlic, etc. Many 
of these spices contain, indeed, a rather large percentage of carbohy- 
drates, but they arc added lo the food in such small quantities that this 
may be disregarded. 

Soiipi : Clear suups and broths, with or without eggs, marrow, 
or dried vegetables (Julienne), clear turtle soup, eto. 

Ckftsr . Strocchino, Neufchatel, old Camembert, Gorgonzola 
ftll other latty or sO'Called cream cheeses. 



Bevsragfi : All kinds of nalutal or artificial carboDaled waters, elllier 
clear or with lemon juice and saccharin or glycerin, or with rum, cognac, 
whisky, arrack, cherry brandy, plum hrandy, NordhSusfr, rye whisky, 
etc. Light Moselle or Rhine wines, claret, or Biu^undy in amounls pre- 
scribed by the physician. Coffee, black or with cream, without sugar, 
but sweetened with saccharin if desired. Tea, clear or with cream or 

TABLE 11. 

Sefoni/ Group. — Foods Permissible in AfoJera/e Quantities. 

These contain carbohydrates, but in so little amounts thai they need 
not be considered, and demand no compensation by a reduction in the 
sUowance of bread. Some of the articles contain a rather large per- 
centage of carbohydrates, but Ihe absolute quanlity in which they are 
consumed is small. 

The amounts here given have beeo fised by piactical experience, and 
it will seldom be found necessary (o increase Ihem. Of the di.shes here 
given, when they are allowed at all, only a few — from two lo four — are 
to be selected each day. It is possible in this way to secure a great 
variety in the patient's dietary. 

Inttmal parts of animals : Calves' liver, giblets — up to loo gm. 

Sausage : Liver sausage, preferably the fatly kinds, liver sausage with 
truffles, black pudding — 90 gm. Meat sausage — So gm. German sau- 
sage. Frankfurter sausage, and the like, brawn, head-cheese, sausage- 
meatballs — 100 gm. 

Patties : Paifi-de-foie gras, potted beef, ham, tongue, salmon, lobster, 
anchovies, etc. — \ to 1 (ablespoonful. 

English sauces, such as Worceslersbire, Harvey, beefsteak, anchovy, 
lobster, shrimp, India soy, China soy^i teaspoonful. 

Cream, (rom 4 to 5 lablespoonfuls a day. 

Cocoa, prepared without sugar — 25 gm. 

Cheese- Emmenthal, Roroadur— 60 gm.; Gervis, Stilton, Brie, Hol- 
land, GruySre — 50 gm.; Edam, Cheddar, Gloucester, Roquefort, Par- 
mesan— 30 gm.; Cheshire, 25 gm. 

I'rg/laila ( prepared -wilhoul Jioiir or sugar) : 5 Tellower turnips j 
salsify, turnip-rooted celery, turnip, cabbage. pumpkin~2 lablespoonfuls ; 
green peas, beans, carrots, Brussels sprouts— I tablespoon fu I ; \\ arti- 
chokes ; 1 truffle ; S medium-sized mushrooms ; i (ablespoonful of morels 
or other edible mushrooms. 

Raw vegetables .■ 8 radishes ; 2 sticks of celeiy ; 2 medium-siied toma- 


Nuts : 2 walnuts ; 6 hazelnuts; 3 almonds; a thin slice of cocoanut; 
8 Brazil nuts. 

Fresh fruits : I thin slice of melon; I small tart apple; I or I J 
peaches ; I spoonful of raspberries or strawberries ; 4 spoonfuls of cur- 
rants ; 6 green gages ; 12 cherries ; J of a medium-sized pear ; corre- 
sponding amounts of other fresh fruits. 


Third Group. — Conditionally Allowable Foods, 

The conditions under which dishes from the following table are per- 
mitted is that an equivalent shall be deducted from the allowance of bread. 
The amounts given below are the equivalents of 50 gm. of white bread, 
containing about 30 gm. of starch. Advantage is taken of the fact that 
larger amounts of certain carbohydrates (cane sugar, milk sugar, fniit 
sugar, etc.) may be allowed than of starch. Some of the dishes given 
in the preceding table appear again here because, if they are eaten in 
large quantities, an account must be taken of the carbohydrates which 
they contain : 

I liter of milk (sweet, sour, or buttermilk). 
i^ liters of kumiss, prepared in the Russian way. 
I to I J liters of kefir, fermented for at least two days and prepared 

without the addition of sugar. 
I liter of cream. 
60 gm. of rye bread, Graham bread, or Hamburg pumpernickel. 
65 gm. of Westphalian pumpernickel. 

100 gm. of aleuronat bread, prepared after Ebstein's formula (con- 
taining 27.5 percent, of carbohydrates and 32 per cent, 
of vegetable albumin ; the aleuronat breads are very vari- 
ably comjx)unded). 
35 gm. of zwieback and simple coffee cakes, made without sugar. 
30 gm. of English cakes of various sorts. 
30 gm. of ** Kichel -cacao" (vStollwerck's). 
50 gm. of chocolate (Stollwerck's). 
40 gm. of chocolate ( French make ) . 
40 gm. of chestnuts shelled or 60 gm. unshelled. 
35 gm. of cane sugar, brown sugar, or rock-candy. 
35 gm. of sweet preserves. 
40 gm. of fruit sugar. 
40 gm. of milk sugar. 


50 gm. of fruit jam. 

40 gm. of honey. 

40 gm. of flour — wheat, rye, barley, buckwheat, millet, or oatmeal 

or cornmeal. 
45 gm. of bean, pea, or lentil flour. 
35 gm. of starch preparations, potato, wheat, or rice, starch, tapioca, 

sago, maizene, mondamin, etc. 
35 gm. of rice. 
35 gm. of farinaceous preparations — noodle, macaroni, oatmeal, 

grits, barley. 
50 gm. of lentil.s, peas, beans (weighed dry). 
100 gm. of green peas. 
180 gm. of new potatoes. 
140 gm. of winter potatoes. 
120 gm. of apples, pears, green gages, plums, damsons, mirabelles, 

apricots, cherries, grapes. 
200 gm. of strawberries, ra.spberries, goo.seberries, mulberries, cur- 
rants, blackberries, whortleberries, blueberries. 
3 peaches. 
40 gm. of figs. 

3 bananas. 
A handful of walnuts, hazelnuts, almonds, or Brazil nuts. 
I liter of beer of any .sort. 
\ liter of sweet wine. 


Fourth Grcntp. — Especially Valuable Foods, 

The great value of the articles contained in the list on the following 
page, of which, however, there is but a small choice, is due in part to 
the high percentage of protein and in part to that of fat. The propor- 
tion of albumin and fat is given for each 100 gm. of the food substance. 
Some contain carbohydrates also, the percentage of which is given for 
the .sake of completeness, but its nutritive value is not counted. 


^^^H IDD Gm, Piolein. 



■B Bacon fsalt or smoked] lo 

DcTonshire cream 3 

Cream cheese (Gervais, Neiilchate], 

Sdlton, Stracchiiici, etc.) . . . ig 
Gennan sausage (Ccrvelalwursl) . l8 

Ham 25 

Cheddar cheese z8 

Fal Pork 14 

Hmoked oi-longnc 24 

Fatty cheese (average) 25 

Volk of ^g 16 

FalgDoae 16 

Fat beef and mutton 17 

Brie cheese 19 

Freah water eel 13 

Smoked mackerel 19 

(^""'Hfe 31 

Fat salmon (fre^h qr smoked) . . 22 
liens' eggs (weighed with the shells) 12 

Carbo- Ciilorie 


Sydenham said : " Great eaters are liable to gout, and 
of these the costive more especially. Eating as they are 
used to eat when in full exercise, their digestion is 
naturally impaired. Even in these cases simple gluttony 
and the free use of food, although common incentives, 
by no means as frequently pave the way for gout as 
reckless, inordinate drinking." This statement is as near 
the truth as anything that has been said since. 

The causes of gout are alcoholism, overeating, heredity, 
indigestion, constipation, and it is also sometimes seen in 
lead workers. 

In the acute attacks the diet should be liquid or semi- 
solid. Milk, bread and miik, and farinaceous gruels are 
usually prescribed. After several days the light meat 
of boiled or baked lish is allowed or a little easily 

[ 01 Doilei 


digestible meat. The increase in the diet is always 
ordered by the physician. 

Chronic Gout. — The diet here is also to be made up 
of simple plainly cooked food, all rich and indigestible 
dishes being prohibited. There is often a peculiar per- 
sonal idiosyncrasy in regard to certain articles of diet, 
and this will largely influence their As a rule, how- 
ever, the following outline will suffice for the guidance 
of the patient : 

Soups of the plainest sorts may be taken, especially 
those consisting largely of vegetables. Yeo has sug- 
gested the use of vegetable purees to which beef extract 
has been added to give them a flavor of meat. Milk is 
valuable in all cases, and where it disagrees it may be 
skimmed, peptonized, or diluted with a carbonated water. 
Bicarbonate of soda may be added when it is desired to 
make the milk alkaline; i to 5 gr. to the ounce should 
be used according to requirements. 

Meat and fish may be taken daily, preferably not at 
the same meal. Fresh beef, mutton, and the like are the 
most suitable meats, and poultry may be allowed for the 
sake of variety. Eggs may be taken in moderation. 

Twice-cooked meats should be avoided, as should 
dried, smoked, or pickled meats, as well as pork and 
veal. Garrod allows bacon at breakfast, but fats are, as 
a rule, to be avoided. Under special conditions, when 
the patierrt's nutrition is poor, they may be given if 

Only the lighter varieties of fish should be given, 
boiled being preferred to fried fish. Oysters and clams 
may be taken, the hard portion being discarded. Salt 
fish, as well as mackerel, salmon, eels, and all other 
heavy fish, should be prohibited. Crabs, lobster, shrimp, 



are usually to 


and the like, as well as 

Vegetables, when they are easily digested, may be 
permitted. Peas, beans, potatoes, artichokes, salsify, 
onions, turnips, greens, cauliflower, and cabbage are all 
allowable, as are Ukewise celery, lettuce, and similar 
green vegetables. Carrots and beets, because of the 
sugar they contain, and asparagus, tomatoes, rhubarb, 
and sorrel, on account of their acid, are best avoided. 
All preserved and pickled vegetables, as well as the 
coarse and fibrous portions of all vegetables, are to be 
omitted from the dietary. 

Fruit is best taken in the morning or during the in- 
terval between meals. It should, as a rule, be avoided 
during the latter part of the day, after full meals or with 
wine. Among the most suitable fruits for the gouty are 
oranges and graf>es. Baked apples or stewed fruit may 
be taken. The sweet juice of the latter is, however, best 
avoided. Garrod advises the avoidance of all stone 
fruits, but allows baked apples and pears and straw- 
berries sparingly. Fothergill suggested that bicarbonate 
of soda be taken with stewed fruit to correct the acidity. 
Opinions differ regarding the use of fruit by the gouty. 
If any particular fruit disagrees with a patient it should, 
of course, be avoided. Patients often manifest idiosyn- 
crasies respecting fruits, and these furnish a guide to 
their suitability. 

When gout is complicated with obesity, diseases of the 
kidneys, diseases of- the stomach or any other disease, 
special diets are ordered. 

Arthritis Deformans. — In this disease there are 
deformities of the bones which are sometimes confounded 
with gout. The diet probably has no influence whatever 



over this disease. Instead of restricting the diet, it should 
be as nourishing as possible. 

Scurvy or Scorbutas. — This disease occurs in adults 
where tiiere is a deficieney of fresh food. It is the scourge 
of armies, and formerly was frequent among sailors. To 
prevent it fresh food should be given. Canned food, 
while not an ideal preventive, is useful. Lemon or 
lime juice, vinegar, and onions are especially valuable as 
preventatives. The treatment of the disease, when it 
occurs, is chiefly dietetic, and consists in giving a good, 
nutritious diet with fresh fruits and vegetables, fresh 
meats and the like. The above-mentioned preventatives 
may be used where the other fresh foods are not available. 

Infantile Scurvy {Barlotds Disease). — Scurvy is fre- 
quently seen in infants, especially between the sixth 
and the fifteenth month. In almost every case improper 
feeding is the cause. It has even occurred where the 
child was breast-fed, but more often from the following 
feeding, in the order of their frequency : the proprietary 
infant foods, sterilized milk, condensed milk, and Pas- 
teurized milk. The treatment is very satisfactory, and 
consists in placing the child upon a proper diet and 
giving in addition fresh orange juice, from ^ to 3 or 4 
oz. daily. The juice of any fresh ripe fruit, as of peaches 
or grapes, may be used instead. 


There is probably no condition that has been more 
widely laymen of both ancient and modern 
times than obesity, for no disease is more thoroughly 
associated in the lay mind with its proper causes and its 
relations to diet than this " oily dropsy", as Bryon 
calls it. 



The accumuiation of fat is associated with increasing 
years, but it is by no means confined either to old or 
middle age, as is exemplified in the fat children familiar 
to all ; obesity may be a plague even of infants. 

The causes of obesity are so well known as to require 
only passing mention. About 50 per cent, of cases owe 
their primary origin to hereditary causes. Women arc 
more frequently affected than men. With the advance of 
years, in some there is a tendency to accumulate fat 
Overeating and overdrinking have been named as cau- 
sative factors, especially when combined with a quiet, 
sedentary life. 

The fats and the carbohydrates are the principal ele- 
ments in the diet that are apt to be converted into fat ; 
but proteins also, if the supply exceeds the demand and 
assimilation is active, will be converted into body-fat and 
stored up in the subcutaneous tissues. The liver and the 
heart are also converted into storehouses for fat, and 
later there may be a fatty degeneration of both organs, 
as well as of the coats of the arteries. 

The dangers accompanying the excessive accumulation 
of fat are manifold, and include a large number of dis- 
eases that may be influenced by it either directly or in- 
directly. These will be discussed when the indications 
for reducing the weight of patients are considered. Weak 
heart, anemia, gout, and diabetes are among the most fre- 
quent diseases with obesity. 

Reduction cures of many kinds are vaunted by their 
respective originators. Ebstein has summed up the 
whole matter in the following sentence: "Corpulence 
can only be permanently cured by a permanent change 
of life and diet regulated by physiologic principles." 

Reduction of weight is in many cases contra-indicated, 


and a reduction cure should never be undertaken without ' 
the advice of a physician. In women especially reduction 
may be a cause of hernia, of dislocation of the kidney, 
or of the uterus, and may also bring on gall-stone colic 
in those who have gall-stone disease. In old people re- 
duction cures are not, as a rule, advised. In many slight 
cases all that is needed is a regulation of the diet and 
life so as to prevent any further increase. Reduction ■ 
may be of especial benefit in stout individuals with heart 
disease, and a method known as " Oertel's method," which 
combines diet and exercise, is usually followed. Reduc- 
tion is also useful in some cases of respiratory disease in 
very stout persons. Bronchitis and asthma may be men- 
tioned in this connection. Where the patient has any 
disease interfering with locomotion, the diet should be so 
arranged that there will be no excessive accumulation of 
fat, as the added weight may be the cause of making the 
patient helpless, 

A much discussed point is whether it is possible to 
reduce any special part of the body more rapidly than the 
remaining parts. This is a method often sought by 
women who have borne several children and who have 
large deposits of fat in the abdominal walls, causing an 
unsightly prominence of the abdomen. If the fat is re- 
duced slowly, every part of the body, including usually 
the abdomen as well, will be reduced simultaneously. If 
it is reduced rapidly, it seems to be removed principally 
from certain parts of the body, as the neck, breasts, arms, 
and calves of the legs. Certain advocates of massage 
claim that the massage of the parts will cause a more 
rapid reduction. Von Noorden had one arm of an obese 
patient massaged for six weeks. At the end of that time 
the arm that had been massaged had increased i \ cm, in 



circumference, whereas the arm that had not been mas- 
saged remained the same. 

Massage of the abdomen during a reduction cure may 
exert a beneficial effect by relieving the constipation, 
which is apt to be troublesome. Exercise is still more 
potent, particularly for reducing the abdomen. This is 
accomplished by standing erect and then bending forward 
in an effort to touch the toes with the tips of the fingers. 
Too much should not be expected from this, even when 
persisted in faithfully. 

Prophylaxis of Obesity. — Where a tendency to 
obesity exists the fat-forming foods should be partaken 
of but sparingly, and sufficient outdoor exercise taken 
to keep the weight within reasonable limits. The fat- 
forming foods are fatty foods of all kinds, the sugars and 

Dietetic Treatment of Obesity. — There are numer- 
ous methods of diet. The method to be used in any 
given case is to be determined by the physician. These 
reduction cures are frequently referred to as Banting 
cures. The Banting method was that used in the case 
of a Mr. Banting, by his physician, Dr. Harvey. It was 
in great vogue some years ago, and the name became 
erroneously applied to many other methods. It is too 
.severe for the average patient. 

Banting Diet for Obesity {Yeo).—" Breakfast, 9 
A. M. : 5 to 6 oz. of animal food-meat or boiled fish (ex- 
cept pork or veal) ; a little biscuit or i oz. of dry toast — 
6 to 7 oz. of solids in all. A large cupful of tea or coffee 
(without milk or sugar) — 9 oz. of liquid. 

"Dinner, 2 p. M. ; Fish or meat (avoiding salmon, eels, 
herring, pork, and veal), 5 to 6 oz. ; any kind of poultry 
or game. Any vegetables except potato, parsnips, beet 


root, turnips, or carrots. Dry toast, i oz. Cooked fruit, 
unsweetened. Good claret, sherry, or Madeira, 10 oz. 
Total of soHds, 10 to 12 oz. 

" Tea, 6 p. M. : Cooked fruit, 2 to 3 oz. ; a rusk or twc^- 
2 to 4 oz. of solids ; 9 oz. of tea {without milk or sugar). 

" Supper, 9 p. M. : Meat or fish, as at dinner, 3 to 4 oz. 
Claret or sherry and water, 7 oz. 

"This allowed only from 21 to 27 oz. of solids per 
diem, of which 13 to 16 oz. consisted of animal food and 
only 3 oz. of bread; the rest consisted of fruit and fresh 
vegetables. There was the strictest possible exclusion 
of starches and sugar. 

"The total fluid was limited to 35 oz." 

Oertel's method is a combination of diet and exer- 
cise, and is especially applicable to patients with disturb- 
ances of the circulatiou. The quality and quantity of 
food and the amount of fluid are carefully regulated by 
the medical attendant according to the patient's condition. 

Bbstein'S method consists in giving a diet in which 
the carbohydrates are reduced, but in which considerable 
amounts of fats are allowed. The custom of giving fatty 
food in such cases is as old as Hippocrates, for he says, 
" The food shall be fat in order to satiate quickly." This 
method is, however, based on an erroneous opinion. 

In general it may be stated that the diet should be 
limited in amount, the starches and sugars reduced to a 
minimum, fats reduced or omitted altogether, and the 
amount of fluid cut down to a very small amount. The 
food given consists of meat, eggs,, fruits, and green 
vegetables. Sufficient exercise is taken to keep the 
weight down to the required number of pounds. 

When obesity is complicated with any other disease, 
the diet may be a point of considerable difficulty. 





In a general way the indications for fattening thin 
people is the reverse for the diet used in obesity. Many 
individuals are thin as a matter of constitution, and such 
as these can not be fattened by any means. There may 
be some special cause for the leanness, and when the 
physician can discover this and remove or relieve it, the 
patient may be increased in weight. Patients emaciated 
from acute illness are readily fattened. 

The patient should lead a quiet outdoor existence, free 
from care or excitement, and should get sufficient sleep. 
The meals should be ample, and as much carbohydrate 
and fatty food taken as possible. Cream, milk and cream, 
butter, cocoa, chocolate, bread, cereals (wel! cooked), 
farinaceous puddings, potatoes, legumes, and sweet fruits 
should all be partaken of in abundance. All sweets — 
honey, syrups, cakes, and the like — ^may be taken if they 
agree with the digestion. Beer, especially the darker 
varieties, porter and brown stout are useful. Sweet wines 
are sometimes ordered, and malt extracts where It is not 
desirable to use alcoholic beverages. Strong alcoholic 
drinks, acids, spices, and many green vegetables are for- 


Certain skin affections are caused directly or indirectly 
by dietary errors ; others are prolonged or intensified by 
an improper diet, and still others are connected in some 
way with diseases of the alimentary tract or with dis- 
turbed metabolism. 

Eczema. — All food which is known to cause erj'thema 
or urticaria in the individual should be avoided, as should 
all food which is liable to undergo fermentation in the 


intestinal tract or which will produce indigestion. Irri- 
tating spices and alcoholic beverages are usually omitted 
from the dietary. The meals should not be too large, 
should be taken at regular intervals, and a simple varied 
dietary should be followed. Gouty and obese patients 
are usually ordered diets suitable for their disease. A 
milk diet is frequently used in persistent cases. 

In infants it is important to have the digestion in per- 
fect order. 

Urticaria {Hives), — Many articles of diet cause hives 
in certain individuals. Among the most frequent causes 
are strawberries, oysters, crabs and other shellfish. 
Partially spoiled or stale articles may also be a cause. 

Acne. — All indigestible articles of food are to be 
avoided, and the diet should consist of easily digested 
fresh food. Excessive quantities of fat should be avoided. 


The Milk Cnre. — Milk is used extensively as a food 
during illness, and it has also been warmly advocated as 
a curative agent, especially by Karell, of St. Petersburg, 
and Weir Mitchell. 

Physicians may prescribe an exclusive milk diet in a 
large number of diseases, chief among which are diseases 
of the kidneys, liver, heart, and intestines. It is also 
at the outset of the rest cure. 

Method of Administration. — Well-skimmed milk from 
the country, as fresh as can be procured, is used. Later 
on the unskimmed milk is often ordered. Karell begins 
with from 3 to 6 oz. three or four time."? a day, and in- 
creases the amount gradually. The milk is to be taken 
slowly, at regular intervals, allowing it to mix with the 
saliva. In winter it is warmed, and in summer given at 
the room temperatwre. After a week, if the stools re- 
main solid, the quantity is increased, 2 liters (quarts) a 
day being given during the second week in favorable 
cases. The regular hours are to be insisted upon. If 
the milk causes diarrhea it is boiled. Constipation is 
regarded as a sign that the milk is agreeing, and the 
bowels may be moved if necessary by laxatives or 
encmata. Small quantities of coffee mixed with the 
morning's milk, or stewed prunes or baked apples in the 
afternoon, are useful in relieving constipation. 

If there is a flatulence, it usually means that too much 



*nilk is being given or that it is not properly skimmed. 
If there is thirst, plain water or a carbonated water may 
be given. Lime water or one of the infant foods may 
be mixed with the milk to render it more digestible. 

During the second or third week, if there is an irre- 
sistible desire for food, a little salt herring or a bit of 
stale bread with salt may be given. Once a day milk 
soup thickened with a cereal may be given. After five 
or six weeks the ordinary diet is gradually resumed, but 
large quantities of milk are still taken. 

During the first week the milk causes slight drowsi- 
ness, a coated tongue, and a peculiar taste in the mouth. 
The stools are light yellow and resemble the milk stools 
of infancy. The urine is increased in quantity. There 
is a slight initial loss of weight, but an increase later on 
in the cure. 

Other Diet Cures. — Many other cures are used in 
various parts of the world. Almost every article of diet 
has at one time or another been vaunted as a "cure." 
Whey, to which alkaline mineral waters have been added, 
is sometimes prescribed with plenty of fruit and vegeta- 
bles and little meat. Kumiss is used in Russia. Grapes, 
apples, and other fruits are used in certain countries. A 
" dry " cure, where the amount of liquid is greatly reduced, 
is sometimes prescribed, especially for A meat- 
and-hot-water cure is used for stomach disorders. The 
Kneipp cure consisted chiefly of a diet of fruit, bread and 
milk, with small quantities of meat and vegetables. The 
cure also directs that the patient walk barefooted in the 
grass while the dew is still on it. 



Surgical o[xrration,s tliat must be performed immedi- 
ately, of course, admit of no preparation. Most opera- 
tions, however, may be postponed for several days or 
longer, thus enabling the patient to be put in good con- 
dition by rest, preferably in bed, and a nourishing, easily 
digested diet. The value of the rest in bed is greatly 
augmented by massage, electricity, and baths where the 
condition of the patient admits of their use; by tonics; 
and by laxatives to correct the tendency to constipa- 
tion that usually exists. 

Anesthesia and Diet. — When an anesthetic is to be 
administered a routine somewhat as follows should be 
^ carried out whenever the circumstances allow : The day 

^ preceding the operation the patient should be kept quiet; 

^B the bowels should be thoroughly emptied by means of 

^1 a saline purge, and the diet should be light and easily 

^B digested. The supper should be a Hght one, and the 

^H breakfast the day of the operation should consist of a 

^f glassful of milk, a cup of cocoa, or a cup of beef tea. 

H If there is great hunger a cracker or a piece of toast 

H may be added. This should be at least two or three 

H hours or even longer before the operation. When the 

^1 surgeon operates early in the morning, the patient is not 

^^ allowed to have any breakfast whatever. If the patient 

^H is weak and in need of a stimulant, an ounce or two of 


brandy or whisky may be given, diluted with a small 
quantity of plain or carbonated water, half an hour be- 
fore the anesthetic is administered. At the time of anes- 
thesia the stomach should, be empty. This is important, as 
it lessens the nausea experienced by many patients after 
anesthesia, and also lessens the danger of vomiting food 
during an operation, an accident which may cause severe 
coughing if the food is drawn into the larynx, or may . 
cause pneumonia if it is drawn into the lungs. The 
coughing and vomiting may interfere seriously with the 

If it is necessary to administer an anesthetic after a full 
meal and ci re um. stances permit, an emetic may be given 
to etnpty the stomach before the operation is begun, or 
it may be better to wash out the stomach. 

Nausea is liable to follow after anesthesia, particujariy 
after the administration of ether ; this is discussed below. 
If nausea does not occur, a cupful of weak tea or of 
diluted milk may be given two or three hours after the 
operation, and if that is retained, milk may be given as 
often as every three hours if desired. For supper, bread 
and milk or cocoa or a slice of toast and a cupful of 
weak tea may be allowed. It is well, however, to wait 
until the following day before giving anything more. On 
the following day, if there is nausea or other untoward 
symptoms, a light breakfast may be given, and after that 
as rapid return to an ordinary diet as circumstances permit 
may be made. 

If there is nausea, or after laparotomies, operations 
about the head, and other operations as outlined below, 
especial care must be taken with the diet of the patient. 

Diet after Operation. — The diet following opera- 
tions should be supervised by the surgeon himself or by 




an assistant especially trained for the purpose. In opera- 
tions about the mouth, as for hare-lip, and on the alimen- 
tary tract, the management of the diet is as of much im- 
portance as the operation itself. In order to avoid the 
interference of well-intentioned but misguided friends, 
many surgeons refuse to operate except in a hospital 
unless the patient is in a condition which does not per- 
mit of his being moved. 

It should be remembered that confinement to bed for 
weeks after an operation greatly impairs nutrition, and 
every effort should therefore be made to get the patient 
in the open air, either on his bed or in a wheel-chair. 
Massage and electricity are employed in suitable cases to 
maintain the nutrition. 

In patients who are up and about no especial diet is, 
as a rule, necessary, except after operations about the 
mouth, larynx, or alimentary tract. The diet should be 
as simple and as nutritious as possible, usually that of 
the ordinary individual. Patients suffering from diabetes, 
gout, dyspepsia, as well as vegetarians, require especial 
care, and the phy.sician will in such cases give explicit 
directions concerning the diet. 

Children should be fed according to the usual rules 
for them, but it is a good plan to have the children, and 
especially infants, in the hospital a few days, so as to get 
them accustomed to the diet on which they will have to 

Those habituated to the daily use of alcohol for years 
should receive a moderate average amount, lest nutrition 
be interfered with or delirium develop. The physician 
will regulate the dosage in these cases. 

Diet After Operations About the Head. — For 
the first few days the diet should be light — usually liquid 


— especially if the brain has been affected, and as nutri- 
tious and as easy of digestion as it is possible to make 
it. The bowels should be kept open. No alcohol is 
allowed except in cases of habitues or on the surg'eoii's 
direction. If the patient is unconscious, it may be neces- 
sary to feed him with a nasal or stomach tube. In some 
cases rectal feeding is used. 

After brain operations, where there are no unusual 
symptoms, the diet may be made semi-solid, or even an 
easily digested solid diet may be allowed after two or 
three days. Milk toast, junket, bouillon and egg, soft- 
boiled or poached eggs, squab, chicken, and the like are 
allowable. The diet should be light, but sufficient in 
quantity, until the patient is up and about, when it may 
be increased to nearly the normal diet. 

In operations of a plastic nature about the face, where 
the taking of food or vomiting is liable to open the 
wound, the food should be given by the rectum until 
all danger of the vomiting is past and until the patient 
can masticate and swallow without fear of injuring the 

Diet After Hare-lip and Cleft Palate Opera- 
tions. — Following these operations especial attention to 
the diet is necessary. The child should be taught to 
take food from a spoon or large medicine-dropper before 
operation. If the breast milk is used, it should be drawn 
from the breast by means of a pump and given with a 
spoon or dropper. Cold sterilized milk or modified milk 
should be used in these cases until the patient is able to 
take other food. Nasal or rectal feeding may be neces- 
sary in .some cases. 

Diet After Esophageal or I^aryngeal Opera- 
tions. — The diet in these cases is of the utmost impor- 



tance and depends very much on the operator and the 
operation done. The surgeon's directions will always be 
explicit in such cases. 

Diet and I^aparotomies. — One or two days before 
the operation the bowels should be cleansed thoroughly 
by a saline or other pui^e, and in the case of an abdomi- 
nal or pelvic operation an enema or two is ordered in 
addition, not only to secure cleanliness, but to obtain rest 
for the bowels. The washing out of the bowel should be 
performed early on the morning of the operation, at six 
or seven o'clock, or at least three hours before the opera- 
tion. No food should be given for at least four hours 
previous to the operation. Many surgeons operate early 
in the morning, before the patient has broken his fast. 
Others operate later in the day, and allow the patient a 
glassful of milk or some such light nourishment on 

As a rule, nothing should be given by the mouth for 
twenty-four hours. Some operators allow very small 
quantities of carbonated water or iced water or very hot 
water, or if the patient is very weak and in need of nour- 
ishment, teaspoonful doses of milk may be ordered with 
or without lime water or a carbonated water. Hot weak 
tea, or if a stimulant is needed, hot black coffee, may be 
administered or alcoholic stimulants may be used. In 
these cases as in all others the nurse acts only under the 
direct orders of the surgeons. Interference or injudi- 
cious feeding may prove fatal. From 5 to 10 oz. of 
liquid food are generally allowed on the second day, and 
from 10 to 15 oz. on the third day. On the fourth day, 
if there are no outward symptoms, a soft diet may be 
ordered, and after a week or ten days a gradual return 
to an ordinary diet may be made. This varies, of 


course, with the operation done and the progress of 
the patient. 

Nausea and Vomiting. — Many operators wash out 
the stomach after tlie operation and before the patient 
recovers from the effects of the anesthetic. This often 
prevents nausea, especially if ether has been given. The 
vomiting and nausea may be transitory, or it may last for 
days or a week or more and even threaten the patient's 

While the vomiting is active no food should be given 
by the mouth. If it persists and the patient is weak, 
rectal feeding is usually resorted to if the operation per- 
mits of it. Various drugs are used to relieve the vomit- 
ing, and sometimes a glassful of hot water is given or 
the stomach is washed out As a rule, total abstinence 
from all food and drink by the stomach is the best way 
to manage these cases. 

Thirst. — This may be almost intolerable. The patient 
may drink the water from hot-water bottles if not watched. 
High rectal enemata of hot water are sometimes used 
while the patient is still on the operating-table, and do 
much toward relieving the thirst of the patient. If allow- 
able, rectal injections of normal salt solution may relieve 
thirst. Sips of hot water or of hot weak tea are fre- 
quently given by the mouth. Carbonated water is some- 
times used, but care should always be taken to allow it 
to efferve.sce partially before giving it, lest the gas accu- 
mulate in the stomach. 

Care of the Bowels.— The bowels are usually 
moved about the third day after an operation. Some- 
times it is desirable to have them moved before; some- 
times to allow them to remain quiet for several more 




days. The surgeon should always be consulted about 
this if specific orders have not been given. 

Dietetic Ma n agement of Shock. — The patient 
will, as a rule, be less shocked if in good condition than 
if unprepared for the operation as outlined above. After 
the operation, in addition to the usual means of external 
heat and the like, stimulating or nutrient enemata may 
be given. The first enema is sometimes given while the 
patient is still on the table. A stimulating enema for an 
adult may contain 2 oz. of brandy, 20 gr. of carbonate 
of ammonium, with sufficient water or beef tea at loo" F. 
to make 8 oz. Another stimulating enema consists of i 
oz. of brandy, the white of an egg, 3 oz. of milk, and a 
pinch of salt. 

Diet After Operations on the Varions Organs. — 
After operations on the liver the diet consists largely of 
protein and carbohydrate food. Fats are, as a rule, not 
well borne, and arc limited in amount or not given at all. 

After operations on the pancreas the amount of fat is 
limited or omitted altogether from the dietary. The use 
of artificially pancreatized food has been suggested. 

After operations ahont the kidney the diet should be 
bland and unirritating, such as has been suggested in 
chronic or even in acute nephritis (inflammation of the 
kidney). All foods known to be irritating to the kidney 
should be withheld. (See Nephritis.) 

Diet After Operations on the Stomach. — The stomach 
and the upper part of the small intestine may be rendered 
sterile or nearly so, and this fact is taken advantage of 
by many operators in surgical procedures about the 
stomach. Finney uses the following diet: For several 
days prior to the operation the stomach is washed out 
twice daily with sterile water, the patient is given sterile 


liquid food served in sterile dishes. Before taking food 
the mouth is thoroughly cleansed with a 1 per cent 
solution of carbolic acid. The food is usually given 
every two hours. 

For four or five days after the operation rectal feeding 
is employed. Normal salt solution enemata are alternated 
with nutrient enemata every four hours. On the fifth 
or sixth day egg albumin is given in teaspoonful doses, 
gradually increased to \ oz. every two hours if it is well 
borne, and finally to i oz. every two hours on the sixth 
day, 2 oz. on the seventh day, and 4 oz. every three 
hours on the tenth day. On the twelfth or thirteenth 
day the patient is given a soft-boiled egg, and the follow- 
ing day soft food, and on the eighteenth day hght solid 

Operators vary a great deal regarding the feeding of 
their stomach cases. Some allow eight days to elapse 
before beginning mouth-feeding, while others begin a day 
or two after the operation. 

Diet After Operations on the Intestines. — After opera- 
tions on the upper part of the intestine the feeding is the 
same as ailer stomach operations. The food should be 
such that but little residue will be left in the intestine. 

After ordinary appendix operations the patient may be 
given liquid diet the second day after the operation ; on 
the third day a soft diet may be allowed, and solid food 
given on the sixth day. On the other hand, if the opera- 
tion has been a serious one and a large pus cavity has 
been evacuated, rectal feeding may be necessary for five 
or six days, and the return to a solid diet may require 

After operations on the rectum the patient is generally 
given a liquid diet for four or five days, after that a soft 


diet, and finally in seven days or longer solid food may 
be prescribed. 

Feeding Through Gastric or Intestinal Fis- 
tulas. — After gastric or intestinal fistulas have been 
made the patient may, if necessary, be fed through these 
openings as early as a few hours after the operation. At 
first only very small quantities of liquid food are given at 
frequent intervals. Kehr advises alternately, every two 
hours, \ cupful of tea with cognac, milk and egg, and on 
the second day wine with peptone. He adds bouillon with 
Ggg on the third day, and begins a " mushy " food, such 
as potato soup, flour soups with ^%%y beef tea, and 
minced breast of chicken, on the eighth day. After three 
weeks the patient may be allowed to masticate his food, 
and then, by means of a rubber tube, pass it into the 
stomach or intestine through the fistula. 


There are wide variations in the diets used in hos- 
pitals, and also in the names applied to them. In the 
average American hospital the classification is as follows ; 

Ward Diet. — This is also known as "full" or "house 
diet." It is the ordinary diet of ail patients for whom 
special diet orders have not been given. 

Light diet, also known as convalescent diet, is that 
used for convalescent patients generally and for others 
for whom it is suitable. It consists of milk, broths, eggs, 
and such other foods as are easily digestible yet nutri- 

Special Diets. — Under this heading are included 
dietary formulas suitable for those diseases in which diet 
plays an important part in the treatment. It includes 
such diets as have been recommended in certain diseases 
and which bear the name of the inventor, as Tuffnell's 
diet for aneurism. Banting's diet for obesity, and such 
general diets as the following : 

Milk Diet. — This is composed entirely of milk, 2 to 
3 quarts usually being allowed daily. 

Meat Diet. — This consists chiefly of nitrogenous 
animal foods, with a minimum of .sugars and .starches. 
It is useful in certain diseases of the stomach where there 
is acid fermentation. It closely resembles the diabetic 

Farinaceons Diet. — This is made up of milk, butter. 



and carbohydrates. It is prescribed for convalescents 
and in chronic nephritis, etc. 

Special or extra special articles of diet, as they are 
often termed, include all articles not on the regular diet 
list for the day, and for which special orders are gen- 
erally given. 




I^ime Water.— Into an earthen jar containing hot 

water stir a handful of fresh unslaked lime. Allow it to 
settle ; then decant the clear fluid and bottle it. Water 
may again be added to the lime, and the mixture covered 
and allowed to stand to be decanted as needed. 

Almond Milk. — Blanch one pound of sweet and two 
of bitter almonds that have been soaked in cold water 
for twenty-four hours. This is done by pouring boiling 
water over the almonds, when, after a few minutes, they 
can easily be pressed out of their hulls. Grind the 
almonds in a mill or pound them in a mortar ; mix with 
a half-pint of warm milk or water, and allow the mixture 
to stand two hours, after which strain through a cloth, 
pressing the juice out well. Thirty grams of almond.s 
yield 200 calories of heat ; 250 grams of milk yield 1700 
calories. — ( Wegelc) 

Brandy-and-eg^g Mixttire. — Rub the yolks of two 
eggs with half an ounce of white sugar ; add 4 ounces 
of cinnamon water and then 4 ounces of brandy. Dose : 
One or two teaspoonfuls every two hours, according to 
age.— (6V,.^,x) 

Brandy-and-egg Mixture for Infants.— Beat up 
well the yolk of a raw egg ; ten drops of brandy ; one 
teaspoonful of cinnamon water; one coffeespoonful of 
white sugar. — {Louis Siarr.) 




Cold Egg-nog. — Beat up an egg ; add to it two tea- 
spoonfuls of sugar, a glassful of milk, and a tablespoon- 
ful of brandy or good whisky ; mix thoroughly. 

Hot Egg-nog. — Heat up the yolk of one egg ; add a 
tcaspoonful or two of sugar and a glassful of hot milk; 
strain, and add a tablespoonful of brandy or old whisky, 
or flavor with nutmeg or wine. 

Egg Broth. — Beat up an egg, and add to it half a 
tcaspoonful of sugar and a pinch of salt ; over this pour 
a glass of hot milk and serve immediately. Hot water, 
broth, soup, or tea may be used in place of milk. — 
(Drexd Instilnh-) 

Egg Cordial. — Beat up the white of an egg until 
light; add a tablespoonful of cream and beat up to- 
gether, then add two teaspoonfuis of sugar and a table- 
spoonful of brandy. 

Caudle. — Beat up an egg to a froth ; add a wine- 
glassful of sherry wine, and sweeten with a tcaspoonful 
of sugar; if desired, flavor with lemon peel. Stir this 
mixture into a half-pint of gruei ; over this grate a little 
nutmeg and serve with hot toast. 

Albumin Water. — Beat the white of one egg until 
very light and strain through a clean napkin. Add six 
ounces of water. If intended for an infant a pinch of salt 
may be added. A teaspoonful or more of sugar and a 
tcaspoonful or more of lemon Juice, orange juice, or 
sherry wine may be added to enhance its palatableness. 
This drink may also conveniently be made by placing all 
the ingredients in a lemonade-shaker, shaking until 
thoroughly mixed, and then straining. Serve cold, 

Apple Water. — Pour a cupful of boiling water over 
two mashed baked apples; cool, strain, and sweeten. 
Serve with shaved ice if desired. 



Tamarind "Water. — Pour a cupful of boiling water 

over a tablcapoonful of preserved tamarinds; allow this 
to .stand until cool, then strain, and serve with shaved ice. ' 

Ctuxant Juice. — Take an ounce of currant juice or 
a tablespoonful of currant jelly. Over this pour a cupful 
of boiling water — use cold water with the juice — and 
sweeten to taste. 

Ifemonade No. I. — Take the juice of one lemon or 
three tablcspoonfuis of Semon juice; add from one to 
three tablespoonfuls of sugar and a.cupfu! (6 ounces) of 
cold water. Serve With cracked or shaved ice if desired. 

lemonade No. 2. — Pare the rind from one lemon, 
cut the lemon into slices, and place both in a pitcher with 
an ounce of sugar. Over this pour a pint of boiling 
water and let it stand until cold. Strain and serve with 
cracked ice. — (Pavy^ 

Effervescing Lemonade. — This may be made by 
using a carbonated water or by adding half a teaspoonful 
of bicarbonate of soda or potash to a glassful of either 
of the foregoing lemonades. 

Albuminized Lemonade.— Shake together a cupful 
of water, two teaspoonfuls of lemon juice, two teaspoon- 
fuls of sugar, and the white of one egg. Serve at once. 

Orangeade. — Cut the rind from one orange ; over 
the rind pour a cupful of boiling water; then add the 
juice of the orange and a tablespoonful of sugar ; cool, 
strain, and serve with shaved ice if desired. If this is too 
sweet, a teaspoonful of lemon juice may be added. 

Imperial Drink. — Add a teaspoonful of cream of 
tartar to a pint of boiling water ; into this squeeze the 
juice of half a lemon, or rnore if desired; sweeten to 
taste and serve cold. This drink is most useful in fevers 
and in nephritis, 



Flaxseed Tea. — Add six tablespoonfuls of flaxseed 
to a quart of water; boil for half an hour; cool, strain, 
sweeten, and if desired flavor with a little lemon juice. 

I/inseed Tea. — To a pint of water add two table- 
spoonfuls of linseed, the juice of half a lemon, \ ounce 
of bruised licorice root (or a piece of licorice the size of 
a filbert), and rock-candy to taste. Boil for one and one- 
half hours and strain. — ( Yeo^ 

Org^eat. — Blanch two ounces of sweet almonds and 
four bitter almond seeds. Add a little orange-flower water 
and pound into a paste ; rub this with a pint of milk 
diluted with a pint of water until it forms an emulsion. 
Strain and sweeten with sugar. (A demulcent and nutri- 
tive drink). — {Pavy^ 

Mulled Wine. — One-fourth of a cupful of hot water, 
one-half inch of stick cinnamon, two cloves, a tiny bit 
of nutmeg, one-half cupful of port (heated), two table- 
spoonfuls of sugar. Boil all the ingredients except the 
wine and sugar for ten minutes ; then add the wine and 
sugar, strain, and serve very hot. — (Drexel Institute) 

Grape Juice. — Pluck Concord grapes from the stem. 
Wash and heat them, stirring constantly. When the 
skins have been broken, pour the fruit into a jelly bag 
and press slightly. Measure the juice and add one- 
quarter the quantity of sugar. Boil the juice and sugar 
together and then pour into hot bottles ; cork and seal 
with paraffin or equal parts of shoemaker's wax and resin 
melted together. Less sugar may be uesd. — {Drexel 

Oatmeal, Barley, or Rice Water. — ^From the 

grain : Use two tablespoonfuls of grain to a quart of 
water. The grain should have been previously soaked 
overnight or at least for a few hours. When required for 

an emergency, the soaking may be dispensed with and 
the grain boiled for five minutes instead. The water in 
which the grain was soaked should be poured off" and 
fresh water added before cooking. The grain should be 
boiled for several hours, water being added from time to 
time to keep the quantity up to a quart. Strain. This 
makes a somewhat thin, watery gruej. 

rrom prepared flours : Various brands of prepared 
grain flours are on the market, such, for example, as 
Robinson's Barley Fiour. These arc all somewhat simi- 
lar ill preparation. From two rounded teaspoonfuls to a 
tablespoonful of the prepared flour is added to a pint of 
boiling water, and this is boiled for from fifteen to thirty 
minutes and then strained. No previous soaking is re- 


Either the grain itself or the specially prepared flour 
may be used. When the grains arc used they should be 
spread on a clean table and all foreign substances re- 
moved. If the whole grains be used, it is well to wash 
them, after picking them over, with two or three changes 
of cold water. 

Cereals are best cooked in a double boiler. The lower 
part should be filled about one-third full of water, and, 
if more is added during the cooking, it should always be 
boiling hot. The cereal should be cooked over the fire 
for ten or fifteen minutes. The water should be boiled 
first and then salted. The cereal is added gradually and 
the whole stirred to prevent it from burning. It should 
then be placed in the double boiler and steamed until 
thoroughly cooked. Cereals, like other starchy foods, 
require thorough cooking. Most recipes allow too short 
a time. Oatmeal especially should be mentioned. It 



develops a better flavor if cooked for three hours of 
more, and is better when it is prepared the day before 
and reheated when used. It should be just thin enough 
to pour when taken out of the boiler, and when cooled 
should form a thin jelly. 

Any cereal mush may be thinned with water, milk or 
cream and made into a gruel, or the gruel may be made 
directly from the grain or flour. Gruels should be thin, 
not too sweet nor too highly flavored, and served very 
hot Milk gruels should be made in a double boiler. 
Gruels may be made more nutritious by the addition of 
whipped egg, either the white or yolk or both, and the 
various concentrated food products. 

When cereal flours are used, the flour should be rubbed 
to a smooth paste with a little cold water and added 
slowly to boiling water, stirring constantly until it is 
thoroughly mixed. 



.. .. 

Irish oattatal : 

IVieattna : 

Gluten musk : 

" 30 ■■ 

Steamed nre : 

Ste»m fo. one 

B0iUJ rUt .■ 

li'iil fur twenly 

Arrowroot Gruel.— Dissolve half a teaspoonful of 
sugar and a quarter of a teaspoonful of .salt in a cupful 
of water, and heat. Mix half a tablespoonful of arrow- 
root flour with a little water and add to the heated water. 
Boil for twenty minutes, stirring constantly; then add a 
cupful of milk, bring to a boil, strain, and serve hot. 

Barley Grael. — Proceed as above, using a table,spoon- 
ful of Robinson's Barley Flour instead of arrowroot. 

Oatmeal Gruel. — As above, but use oatmeal, and 

boil for half an hour or longer before adding the milk. 

Flour Gruel. — Proceed as in making arrowroot gruel, 
using instead a tablespoonful of wheat flour. Flavor 
with lemon juice, cinnamon, nutmeg or vanilla. 

Farina Gruel. — Proceed as in making arrowroot 
gruel, using instead a tablespoonful of farina, and boil 
but ten minutes before adding the milk. 

Imperial Granum Gruel. — As in the preceding, 
but use imperial granum instead of farina. 

Cracker Gruel No. i. — Use two tablcspoonfuts of 
cracker crumbs and proceed as above. Cook only two 
or three minutes and do not strain. 

Cracker Gruel No. a. — Brown the crackers, and 
reduce to a powder by means of a rolling-pin. Add 
three tablespoonfuls of the powdered crackers to haif a 
cupful of milk and half a cupful of boiling water; cook 
for ten minutes; then add one-fourth of a teaspoonful 
of salt and serve. — {Drcxel Institute^ 

Racahout des Arabes.— This is a French prepara- 
tion with a chocolate flavor which makes a most delicious 
gruel. Follow the directions given for farina gruel. 

Flour Ball. — Tie half a pint of flour in a square of 
fine cheese cloth, making a ver>' tight ball. Place this in 
a pot of boiling water and cook for four or five hours. 
After taking out of the cloth, peel off the outside and 
grate the hard ball. Drj- in the oven and keep in a cov- 
ered Jar. This is useful for making gruels for diluting 
milk for infants. 

Flour-ball Gruel.— Proceed as for arrowroot gruel, 
using two teaspoonfuls of the above grated flour Tubbed 
up in cold water, and stir into a pint of boiling water. 
Cook this for ten minutes. 




Commeal Gruel No. i. — Use two tablespoonfuls of 
cornnieal and one of flour, a teaspoonful each of sugar 
and salt, one quart of hot water and a cupful of milk. 
Proceed as in making arrowroot gruel, boiling in a double 
boiler for three hours. 

Commeal Gmel No. 2.— Take a tablespoonful of 
cornmeal and moisten with a little cold water. Stir this 
into a pint of boiling water to which a pinch of salt has 
been added. Cook for three hours in a double boiler, 
or for thirty minutes directly over the iire. In the latter 
case it must be stirred constantly. 

Glnten Gmel. — Mix a tablespoonful of gluten flour 
with one-fourth of a cupful of cold water and stir this 
into one cupful of boiling salted water. Cook directly 
over the fire for fifteen minutes ; then add one clove and 
cook over boiling water for a half-hour. — {Drexel Insti- 

Barley or Oatmeal Jelly. — Prom the grain : Pre- 
pare the grain as directed for barley water. Use from 
four to .six tablespoonfuls of grain to the quart of water. 
Boil thoroughly for several hours until the grain is 
thoroughly cooked. Strain and cool. The jelly when 
hot should be thick enough to pour. 

From the prepared flours : Use two tablespoonfuls of 
the flour to a pint of water. Boil from fifteen to thirty 
minutes and strain. 

Partially Digested Cereals Prepared at the 

Table. — To a sauce of well-cooked oatmeal, wheaten 
grits, or rice, at the customary' temperature, add one or 
two teaspoonfuls of Fairchild's Diastasic Essence of Pan- 
creas, or fifteen grains of Fairchild's Dry Extract of Pan- 
creas. Stir for a few minutes before eating. When the 


rerments are added to very hot foods their power becomes 

Tapioca Jelly. — Soak a cupful of tapioca of the best 
quality in a pint of coid water for two hours ; when soft, 
place in a saucepan with sugar, the rind and juice of one 
lemon, a pinch of salt, and another pint of water ; stir 
the mixture until it boils ; turn into a mold and set away 
to cool ; if desired, a glassful of wine may be added. — 

Tapioca Soup.— Boil a pint of meat broth or stock, 
and, while stirring constantly, .sprinkle in \ ounce of pre- 
viously washed tapioca. Cover the saucepan, and let it 
stand until the tapioca is quite soft. Skim and serve.— 

Chestnut Puree. — One pound of chestnuts are peeled, 
and boiled in water until the second (inside) .skin comes 
off easily. The chestnuts are placed in a sieve until all 
the water drains off They are then washed in a dish 
and afterward pres.sed through a sieve. Melt three 
ounces of butter in a stewpan on the fire, add a little 
salt and sugar — enough to cover the point of a knife — 
and then the chestnuts. Stow them for half an hour, 
stirring frequently ; pour in enough bouillon so that the 
mush does not get too thick. — (IFf^f/f.) 

Drexel Institute Bread Recipe. — For two loaves 
take two cupfuLs of wai'm milk or water, two tcaspoon- 
fuls of .salt and two of sugar, a tablespoonful of lard or 
butter, one-half cake of compressed yeast, and about four 
pounds of flour. Put the water or milk, salt, sugar, and 
fat into a bowl. Dissolve the yeast in warm water ; add 
it and the flour gradually ; when stiff enough to handle, 



turn the dough on a floured board and knead until soft 
and elastic. Put it back into thf bowl, and let it rise in a 
warm place until it is double its bulk. Then divide into 
loaves or shape into biscuits. Allow these to rise in the 
pan in which they are to be baked. Cover the bread and 
again allow it to double its bulk. Bake loaves one hour 
in a hot oven. The large amount of yeast allows the 
bread to be made and baked in three hours. 

Brown Bread.— Take one-half cupful scalded milk, 
one-half cupful water, one teaspoonful salt, one-half 
tablespoonful butter, one-half tablespoonful lard, two 
tablespoonfuls of molasses, one-half cupful white flour, 
suflicient Graham flour to knead, and three-quarters of a 
yeast cake dissolved in one-quarter of a cupful of luke- 
warm water. Prepare the same as white bread. Instead 
of Graham flour, equal parts of Graliam flour and white 
flour may be used in kneading. 

Nat-brown Bread.^Thc same as preceding, with 
one cupful of nuts chopped and added. 

Whole-wheat Bread. — Dissolve a quarter of a 
yeast cake in a tablespoonful of lukewarm water. Pour 
half a cupful of hot water over half a cupful of milk, 
and when lukewarm add the yeast and half a teaspoonful 
of salt. To this add a cupful of whole-wheat flour and 
beat for five minutes. Cover and allow this to stand in a 
warm place for two hours and a half. Then add whole- 
wheat flour gradually, mixing the mass until it can be 
kneaded. Knead until elastic ; shape and place into 
baking-pans, ^over and allow to .stand in a warm place 
until it doubles its bulk. Prick the top with a fork and 
bake for one hour. The oven should not be hot as for 
white bread. 

Polled Bread.— Use bread made with water. Make 

Potatoes .... 

Carrots .... 


Beets (uldj . . 

Onions .... 

. .4S-6S 

CabbBge . . . 

. tS-'-o 

Cauliflower . . 

Asparagus . . . 


into long loaves, and as soon as baked take off the crust. 
Pull into stick-shaped pieces and browa slightly in a slow 



Wash thoroughly ; pare or scrape if skins must be 
removed. Stand in cold water until cooked, to keep 
them crisp and prevent their being discolored. Cook in 
boiling water; the water must be kept at the boiling- 
point. Use two teaspoonfuls of salt with two quarts of 
water ; put the salt into the water when the vegetables 
are partially cooked. The water in which vegetables are 
cooked is called vegetable stock. 

Fresh green vegetables require less water thatvothers. 

Cabbage, cauliflower, onions, and turnips shauld be 
cooked uncovered in a large amount of water. 

All vegetables must be drained as soon as tender. 
Season with salt and pepper and serve hot with butter or 

The color may be kept in green vegetables, such as 
spinach, by pouring cold water through them after 

Cold vegetables may be used for salads or may be 



placed in a baking-dish with one-half the quantity of 
sauce (2 cupfuls vegetables and i cupful sauce), covered 
with buttered crumbs, and browned in a hot oven. 

Sauce for Vegetables : 

3 tablespoonfuls of butter. White pepper. 

3 tablespoonfuls of flour. I cupful of milk. 

I teaspoonful of salt. I cupful of stock. 


(Drexfx Institute.) 

These soups are thickened by using butter and flour ; 
this prevents a separation of the thicker and thinner 
parts of the soup. The butter should be heated until it 
bubbles, the flour and seasoning added, and enough of 
the hot liquid to make a smooth sauce thin enough to 
pour easily ; this should be poured into the rest of the 
hot liquid and cooked in a double boiler until the soup 
is of the proper consistence. 

In soups made of dried peas and beans soda is used 
to soften the casein ; it is also used in tomatoes to neu- 
tralize the acid. These soups must be served in hot 
dishes as soon as ready. Crisp crackers, croutons, or 
soup sticks may be served with them. 

Crisp Crackers: 

Split and butter thick crackers and brown in a hot oven. 

Cream-of-Tomato Soup : 

I can tomatoes. J cupful of flour. 

\ teaspoonful soda. 3 J teaspoonfuls of salt. 

J cupful of butter. \ teaspoonful of white pepper. 

I quart of milk. 

Stew the tomatoes slowly one-half to one hour, strain, and add soda 
while hot ; make a white sauce and add the tomato juice. Serve imme- 

Cream-of-Celery Soup : 

I J cupfuls of celery, 

2 lablespwinfuls of butter. 

I pint of walei. 

J cupful of Hour. 

I cupful of milk. 

^ teaspoonful of salt. 

I cupful of cream. 

J teaapoonful of white pepper. 

Cook Ihe celery in the boiling wat 

er until very soft ; strain and add the 

liot liquid ; make a while sauce and 

cook until it is thick cream. 

Cream-of-Potato Soup 

3 pulatoes. 

Volks of 2 eggs. 

2 cupfuls of milk. 

I teaspoonful of salt. 

^ cupful of cream. 


j teaspoonful of onion juice, 
'ook the potatoes until soft, drain, mash, add the hot liquid, and 
in ; add the beaten yolks and seasoning. Cook in a double boiler 
il the egg thickens, stirring constantly. Serve immediately. 

Oyster Stew : 

1 cupful of milk. 
I pint of oysters. 

^ teaspoonful of salt. 
I tablespoonful of bntter. 

Heal the milk. Cook and strain the oyster juice. Add the oysters, 
which have been rinsed, and cook until the edges curl. Add seasoning, 
butter, and hot milk. Serve at once. This soup may be thickened with 


Partially Peptonized Milk.— Into a clean granite- 
ware or porcelain-lined saucepan place one pint of milk, 
four ounces of water, and the contents of one of Fair- 
child's peptonizing tubes, or five grains of pancreas 
extract and fifteen grains of bicarbonate of soda. Heat 
gradually until it boils, stirring constantly. Boil gently 
for ten minutes, strain into a clean bottle, cork, and keep 
in a cool place. Before using shake the bottle well ; 
serve hot or cold. Prepared in this way it will not 
become bitter. 


Peptonized Milk.— Cold Process. — Mix milk, water, 

and peptonizing agents as directed in the preceding 
recipe, and immediately place the bottle on ice. Use 
when ordinary' milk is required. This is particularly 
suited for dyspeptics and individuals with whom milk 
does not, as a rule, agree. The flavor of the milk re- 
mains unchanged. 

Peptonized Milk. — Warm Process. — Put in a glass 
jar one pint of milk and four ounces of cold water ; add 1 
five grain.s of extract of pancreas and fifteen grains of! 
bicarbonate of soda. After mixing thoroughly, place thefl 
jar in water as hot as can be borne by the hand (aboufej 
1 15° F.). This should be heated for from six to twent> 
minutes. At the end of this time it may be placed upon^ 
ice until required. The contentf of one of Fairchild's 
peptonizing tubes may be used in place of the pancreas 
extract. If the milk is to be kept for any length of time, 
it .should be brought to a boil, to prevent the formation 
of too much peptone, which renders the milk bitter. 

Hot Peptonized Milk. — Mix together the usual 
peptonizing ingredients and add a pint of fresh cold 
milk ; after thoroughly shaking the bottle, place it on 
ice. When needed pour out the required amount, heat 
it, and drink it as hot as it can agreeably be taken. If 
required for immediate use, the ingredients may be mixed 
together in a saucepan and slowly heated to the proper 

Effervescent Peptonized Milk. — Put some finely 
cracked ice in a glass; fill it half-full of Apollinaris, 
Vichy, or siphon water, and immediately add tlie pep- 
tonized milk. Drink while effervescing. Brandy may 
be added if desired. 

Specially Peptonized MUk. — This is to be used in 



the preparation of jellies, punches, and all recipes where 
the milk is to be mixed with fruit juices or acids. Pre- 
pare according to the hot process ; keep the milk at a 
temperature of 115° F. for one hour; pour into a sauce- 
pan and bring to a boil. If required hot, this may be used 
immediately, or it may be set aside on ice, to be used 
later. If not heated for an hour, the milk will curdle 
on being mixed with an acid. If not boiled, the pep- 
tonizing ferment will digest gelatin and prevent the forma- 
tion of j'jlly. 

Peptonued Milk Jelly. — Soak well half a box of 
Cox's gelatin in four ounces of water. Take one pint 
of hot specially peptonized milk and add four ounces of 
sugar. Put in the gelatin and stir until it is dissolved. 
Pare one fresh lemon and one orange, and add the rinds 
to the mixture. Squeeze the lemon and the orange 
juice into a glass, strain, and mix with two or three 
tablespoonfuls of St, Croix rum, or brandy, if preferred. 
Add the juices to the milk, stirring constantly. Strain, 
and allow it to cool to the consistence of syrup ; when 
almost ready to set, pour into cups and set in a cold 
place. Do not pour the milk into molds until the 
mixture is nearly ready to set, otherwise it wili separate 
in setting. 

Peptonized Milk Punch.— In the usu:il milk punch 
recipes the spcdally peptonized milk may be used in 
place of ordinary milk. Take a goblet one-third full of 
finely cru.shed ice; pour on it a tablespoonful of rum 
and a dash of Curacao, or any other liquor agreeable to 
the taste. Fill the glass with peptonized milk ; stir well, 
sweeten to ta.ste, and grate a little nutmeg on top. 

Peptonized Milk I,emonade.— Take a glass one- 
third full of cracked ice; squeeze into this the juice of a 



lemon, and add two or three teaspoonfuls of sugar di^^ 
solved in water. Fill the glass with fresh sj>ecia//jn 
peptonized milk and stir well. If preferred, equal partSfl 
of milk and of an effervescent mineral water may be3 
used. Pour the water on the lemon juice and ice, andfl 
immediately fill the glass with milk. M 

Peptonized Milk Gruel. — Mix with a teaspoonfuU 
of wheat flour, arrowroot flour, or Robinson's Barleys* 
Flour with half a pint of cold water. Boil for fivel 
minutes, stirring constantly. Add one pint of cold miUcl 
and strain into a jar; add the usual peptonizing ingre-^ 
dients; place in warm water (i 15° F.)for twenty mimites^ 
and then upon ice. ■ 

Junket, or Curds and Whey. — Take a half-pint o^ milk ; add one tcaspoonful of Fairchild's Es-sence"-! 
of Pepsin and stir just sufficiently to mix. Pour into | 
custard cups, and let it stand until firmly curdled. It 1 
may be served plain or with sugar and grated nutmegs J 
It may be flavored with wine, which should be added I 
before curdling takes place. I 

Junket with Bgg.— Beat one egg to a froth, and-1 
sweeten with two teaspoonfuls of white sugar ; add this-^l 
to a half-pint of warm milk ; and then add one teaspoon-v 
fnl of essence of pepsin and let it stand until curdled. I 
Cocoa Junket. — Put an even tablespoonful of anyj 
good cocoa and two teaspoonfuls of sugar into a sauce*! 
pan; scald with two tablespoonfuls of boiling water and'a 
rub into a smooth paste ; then .stir in thoroughly one-half '| 
pint of fresh, cool milk; heat this mixture until it is 1 
lukewarm — not over 100" F. — then add one tea.spoonful j 
of Fairchild's Essence of Pepsin and stir just enough to. 
I mix ; pour quickly into small cups or glasses, and let tt A 
L stand until firmly curdled, when the junket is readyfof"J 

AEC/PES. 301 

use. It may be placed on ice and eaten cold ; as a 
dessert it may be served with whipped cream. — {Fair- 

Coffee Jnnket. — Dissolve two teaspoonfuls of sugar 
in two tablespoonfuls of clear, strong coffee ; mix tliis 
thoroughly with one-half pint of fresh, cool milk ; add a 
tea.spoonful of Fairchild's Essence of Pepsin as directed 
above, and serve in the same way. 

Vanilla, Bitter Almond, or Strawberry Junket. 
— Add the flavoring extract to the cold milk and then 
prepare in the usual way. A half a teaspoonful of vanilla 
or bitter-almond extract or a tablespoonful of pure con- 
centrated .strawberry syrup should be allowed to a half- 
pint of milk. 

Milk I,enionade. — Take two ounces of sugar, five 
ounces of boiled milk, one^half lemon, or two ounces of 
white wine, five ounces of boiling water, and the rind of 
half a lemon. Pour the boiling water over the peel and 
the sugar; allow it to cool, add the milk, and then the 
lemon juice or wine. Strain after ten minutes. 

Hilk Pdnch. — Shake together in a lemonade-shaker 
a glass of milk, a tablespoonful of rum, brandy, or good 
old whisky, and two teaspoonfuls of sugar. After it has 
been poured into a glass a little nutmeg may be grated 
over the top. 

Milk Porridge. — Mix a tablespoonful of flour with 
one-fourth cupful of cold milk and stir into one-fourth 
cupful of hot milk; if desired, add two raisins cut into 
quarters. Cook over boiling water for one hour, and 
add one-quarter teaspoonful of salt just before serving. 
— {Drcxd liistitut,-) 

Whey.— Take a half-pint of fresh milk heated luke- 
warm (115° F.), add one tablespoonful of essence of 



pepsin, and stir just enough to mix. When this is firmly- 
coagulated, beat up with a fork until tht curd is finely 
divided and then strain. For flavoring purposes lemon 
juice or sherry wiiic may be added. 

Cream-of-tartar Whey. — Add a heaping teaspoon- 
Tul of cream of tartar to a pint of boiling water. Strain, 
sweeten to taste, and serve cold. — (^I'avy.) 

Wine Whey.— Cook together a of milk and 
iialf a cupful of sherry wine. As soon as the curd 
separates, strain and sweeten. This may be eaten hot 
or cold. 

I/emon Whey. — This is made in the same way as 
the foregoing recipe, using three tablespoonfuls of lemon 
juice instead of the wine. 

Kumiss No. i. — Take a quart of skim milk, one- 
fifth of a cake of, and two tablespoonfuls of sugar. 
Heat the milk. Dissolve the in a little water and 
mix it with the .sugar and lukewarm milk. Pour the 
mixture into strong bottles, stopper them tightly with 
new corks, and tie down the corks with stout twine. 
Shake the bottles well and place in a refrigerator; this 
will allow the mixture to ferment slowly. After three 
days lay the bottles on their sides, turning them occa- 
sionally. Five days are required to complete the fer- 
mentation; the kumiss is then at its best. — {Drexd 

Kamiss No. 3. — Pour into wired bottles one quart of 
fresh milk, half an ounce of sugar, a piece of fresh yeast 
cake half an inch square, and keep at a temperature be- 
tween 60° and 70° F- for one week, shaking five or six 
times a day; then put upon ice. — {Holt) 

Hilk Mixture. — This is made of cream, two parts ; 
milk, one part ; lime water, two parts ; sugar water, 



three parts (seventeen and three-fourths drams of milk 
sugar to a pint of water). — (-J. V. Meigs^ 

Milk-and-cinnamon Drink. — Add a small amount 
of cinnamon to the desired quantity of milk and boil 
it Sweeten with sugar and add brandy if desired, — 

Albuminized MUk. — Shake in a covered jar or 
lemonade-sliaker acupfuiof milk, a tablespoouful of lime 
water, and the white of an egg. Sweeten, flavor as de- 
sired, and serve at once. 

Milk-and-cereal Waters. — A most valuable method 
of preparing milk for invalids with whom it disagrees is 
to mi.*; equal parts of milk and thoroughly cooked 
barley, rice, oatmeal or arrowroot water and boil them 
together for ten minutes. This may be served plain, or 
flavored by cooking with it a cut-up raisin, a sprig of 
mace, or a piece of stick cinnamon, which should be 
strained out before serving. 

Irish Moss and Milk.— Soak about two tablespoon- 
fuls of Irish moss for five minutes and wash thoroughly 
in cold water. Add to a cupful 'of milk and soak for 
half an hour; then heat slowly, stirring constantly, and 
then boil for ten minutes, preferably in a double boiler; 
strain, and pour into cups and cool. This maybe served 
while hot, and may be rendered more nutritious by the 
addition of the white of an egg stirred into it just before 

Milk with Other Diluents.— Milk may be diluted 
with advantage in many cases by adding lime water, or 
Vichy, Apollinaris or some other sparkling table water. 
From one-half to one-eighth the total volume may be 




BRRS arc exceedingly valuable as food for invalids. 
They should always be fresh. When received they 
should be washed and then placed in a cool place. They 
should not be kept with any article of food having an 
odor, as they absorb such odors and the taste is thereby 
impaired. Stale eggs will not sink, and if held to a 
bright light they show a dark spot. The yolk of an egg 
that has been broken may be kept fresh by placing it 
(unbroken) in a cupful of cold water. This should be 
set in a cool place. This will keep it fresh for twenty- 
four hours or more. 

ICggs and all other albuminous food should be cooked 
at as low temperatures as possible, in order to avoid 
rendering them tough, 

ICggs are best cooked in the shell as follows : 

Soft-cooked Eggs. — Place in a pint of boiling water, 
remove from the fire, and allow to stand for eight or ten 
minutes. If the egg is very cold to start with, it will 
take a little longer. 

Hard-cooked Eggs. — Place in water, bring to a boil, 
and then set on the back part of the stove for twenty 

I^ggs should be served as soon as cooked, and the 
dishes should be warmed and ready. 


Rules for Custards. — The eggs should be thor- 
oughly mixed but not beaten light, the sugar and salt 
a(kled to these, and the hotmxW added slowly. Custards 
must be cooked over rrioderate heat; if a custard curdles, 
put it in a pan of cold water and beat until smooth. 
Custards should always be strained. — (Drexel Institute) 


Soft Custard.— Take a pint of milk, the yolks of two 

eggs, two tablespoonfuls of sugar, and a pinch of salt. 
Mix all except the milk in a bowl. Heat the milk to the 
boiling-point and add, stirring constantly. As soon as 
mixed, pour into the saucepan in which the milk has been 
heated and cook from three to five minutes, stirring con- 
stantly until it thickens. Strain, and pour into a cold bowl, 
and flavor with from half to one teaspoonful of vanilla, 
a teaspoonful or more of sherry, or other flavoring ma- 
teria! as desired. Custards may be cocked to advantage 
ill a double boiler. 

Chocolate Custard. — Melt half an ounce of Baker's 
chocolate and add to the milk, and proceed as above. 

Steamed Custard. — Mix the above, using the whole 
eggs instead of the yolks. Strain, pour into cups, and 
steam over boiling water until firm. 

Baked Custard. — Proceed as above, but pour the custard 
into baking-cups. Place the cups in a deep baking-pan 
and fill the pan nearly as high as the cups with boiling 
water. Place in the oven and bake twenty minutes or 
longer, according to the size of the cup. When done a 
clean knife thrust into the custard comes out clean ; if it 
is not done, it comes out covered with milk. 


General Rules for Preparing Meat. — Meat must 
be weighed, trimmed, and wiped with a damp cloth. It 
should be removed immediately from the paper in which 
it was wrapped and placed in a cool place. Only tender 
cuts of meat should be broiled, pan-broiled, or roa.sted. 
When meat is to be cooked by any of these methods, it 
should first be seared, and then the temperature slightly 
lowered ; by searing, the albumin on the outer surface of 


the meat is hardened and the meat is thus cooked in its 
own juices. 

Tough meat should be cooked in water ; boiling water 
hardens the albumin on the outer surface of the meat 
and prevents the juices from escaping. Meat should be 
put in boiling water and the water allowed to boil for ten 
or fifteen minutes ; then the cooking should be allowed 
to proceed at a low temperature until the meat is tender. 
If the water bubbles, it is too hot. Cooked in this way- 
tough meat will become tender. The time required for 
roasting or cooking in water varies with the weight and 
quality of the meat. 

For roasts weighing less than 8 pounds allow ten min- 
utes to the pound and ten minutes extra ; for those weigh- 
ing from 8 to 12 pounds, allow twelve minutes to the 
pound and twelve minutes extra ; for those weighing 
over 12 pounds, allow fifteen minutes to the pound and 
fifteen minutes extra. For meat weighing less than lo 
pounds, to be cooked in water, allow twenty minutes to 
the pound and twenty minutes extra. 

The time required for broiling meat varies with the 
thickness of the meat. 

Stock and broth are prepared by prolonged soaking 
of the meat in cold water and then cooking it at a low 
temperature for several hours, allowing it to cool uncov- 
ered. The meat that remains after straining may be 
utilized in various ways, adding a little fresh meat to give 
it flavor. 

The fat must not be removed from stock or broth, for 
it excludes the air and prevents decomposition. It must, 
however, be entirely removed before the stock or broth 
is used ; this fat may be used in place of drippings. The 
trimmings of fat from meat should be clarified. Small 


globules of fat may be removed from cold broth with a 
cloth that has been dipped in boiling water and then 
wrung dry. Fat may be removed from hot broth by 
means of tissue-paper or a slice of bread. 

Cooking Tender Meats. — Roasting. — Skewer the meat 
into shape. Place it on a rack in a meat pan, into the bot- 
tom of which pieces of fat from the meat have been placed. 
Put in a hot oven on the grate for ten minutes, to sear 
the meat If desired it may be seasoned with salt and 
pepper. Then retnove to the floor of the oven and baste 
every ten minutes, until it is done. 

Broiling. — Remove extra fat from the meat and grease 
the broiler with a part of the fat. Broil over a clear fire ; 
sear, and then turn every ten seconds. Chops one inch 
thick should be cooked for five minutes. A steak two 
inches thick should be cooked for ten minutes. Season 
and serve on a hot platter. 

Pan-broiling.— Remove all the fat from the meat. Heat 
a frying-pan very hot, but use no fat. Sear the meat on 
both sides, and then cook more slowly until it is done. 
Stand chops up on their edges to brown. Keep the pan 
free from fat. The time required for pan-broiling is the 
same as that required for broiling. — {Drcxd Institute.) 

Both meats and vegetables should be cut into small 
pieces. The soup should be started with cold water 
poured over the meats and the heat applied gradually 
and the soup allowed to simmer, in order to dissolve as 
much of the nutriment as possible. If heated rapidly 
the albumin in the meat coagulates, and little but the 
extractives passes into the soup. The vegetables are 
added when the soup is nearly done. 


Remove the fat by skimming, by using blotting-paper, 
by straining through a cloth wet in cold water, or, best 
of all, by cooling the soup when all the fat rises to the 
top, when it can be easily removed. 

Clear soups may be rendered more nutritious by the 
addition of sago or of some cereal, as barky or rice. 
These may also be added with advantage to many thick 

Soups should always be served hot. Soup jellies are 
served cold, and in hot weather may be substituted for 
warm soups. 

Soups may also be made from soup stocks, which may 
be prepared in any quantity and kept for several days. 
Stocks may be made from any meat. Those made from 
chicken or veal are light in color, and those from beef 
and mutton somewhat darker. Stocks may also be made 
by using the bones from any kind of meats. 

Soup Stock. — To make stock, use a chicken or 
several pounds of bones with some meat attached, or a 
pound of lean meat and one quart of water. Cut-up 
vegetables may be added as desired. For flavoring add 
a sprig of parsley and of celery, a peppercorn, a small 
onion, and a scant teaspoonfu! of salt. Any of the 
flavoring vegetables may be omitted as desired or others 
added. The meat should simmer for several hours, until 
but half the quantity of water remains. Then add the 
other ingredients, simmer half an hour longer, strain and 
cool. Remove the fat. 

Soup Stock from Beef Eitract. — Cook the other in- 
gredients, except the salt, as given above, for half an 
hour, using a quart of water. Then add a teaspoonful 
of beef extract and a quarter of a teaspoonful of salt. 

Soup from Stock. — Rice, tapioca, or whatever is de- 



sired is cooked and the stock added, with additional 
seasoning as thought necessary. Cream, yolks of eggs, 
Irish moss, cornstarch or arrowroot may be added to 
render the soup more nutritious. 

Chicken Broth. — Take one pound of cliicken and a 
pint of cold water. Clean the fowl, cut it into pieces, 
and remove the skin. Separate the meat from tlic bone 
and chop the meat very fine. Place with the bone.'i — if 
large, they should be broken — in the water and soak for 
an hour. Cook over hot water for four or five hours at 
a temperature of 190° F, Strain and add salt. Water 
must be added from time to time to keep the quantity 
up to a pint. Remove the fat. If the broth is to be 
reheated use a double boiler. 

Sweethread Soup. — The sweetbread is soaked in 
cold water for one hour, the water being renewed fre- 
quently during this time. It is then boiled for one hour 
in slightly salted water or beef broth, to which one may 
add one teaspoonful of julienne to improve the taste. 
Afler it is soft the sweetbread is taken out of the beef 
broth and all blood-vessels and skin are removed. It 
may now be cut into pieces the size of a walnut and 
put on a plate, over which the beef broth is poured, or 
the sweetbread may be forced through a sieve, beef 
broth poured over this, and the whole put on the fire 
again until it boils, after which the soup may be served. 
This latter process is to be recommended in the case of 
dyspeptics. One hundred grams of raw sweetbread 
generate about 90 calorics of heat. — (U'l'^c/f.) 

Meat Broth (Beef, Veal, Mutton, or Chicken).— 
Cover one pound of chopped lean meat with one pint of 
water and allow it to stand for from four to six hours. 
Then cook over a 'slow fire for an hour until reduced 


to half the quantity. Cool, skim, pour into jar and 

Veal Broth. — Pour a pint of water on a half-pound 
of finely chopped lean veal and allow it to stand for 
three hours. Boil for a few minutes, strain, and season 
with salt. 

Clam or Oyster Juice.— Cut the clams or oysters 
into pieces and heat for a few minutes in their juice. 
Strain through muslin and serve while hot. In straining 
great care must be taken that sand does not pass through 
the muslin. The juices should be diluted and may be 
frozen. — {Drexd Institute) 

Clam Broth. — Wash three large clams very thor- 
oughly, using a brush for the purpose. Place in a kettle 
with half a cupful of cold water. Heat over the fire ; as 
soon as the shells open the broth is done. Strain 
through muslin, season, and serve. — {Drexel Institute) 

Mutton Broth with Vegetables. — Allow one 
pound of neck of mutton to each pint of water; add 
carrots, turnips, onions, and barley; let all simmer 
together for three hours. 

Mutton Broth without Meat. — Cook two " shank- 
ends" in a pint of cold water, and vegetables as directed 
in the foregoing recipe; simmer for three hours and 


Beef Tea No. i. — Cut up a pound of lean beef into 
pieces the size of dice ; put it into a covered jar with 
two pints of cold water and a pinch of salt. Let it 
warm gradually and simmer for two hours, care being 
taken that it does not at any time reach the boiling- 
point. — ( Yeo) 

Beef Tea No. 2. — Put a pound of finely mixed beef 
with a pint of cold water into a suitable vessel. Let it 

stand for an hour, stirring occasionally. Put the vessel 
containing the beef into a saucepan of water, place it 
over the fire, and allow the water to boil gently for an 
hour (or the vessel containing the beef tea may be put 
into an ordinary oven for an hour). Pass the beef tea 
through a strainer. A fine sediment appears in the fluid, 
and this should be drunk with the liquid. Flavor with 
salt. At no time should the beef extract be exposed to 
a temperature of more than 170° F. — {Pary) 

Beef Tea No. 3. — Chop fine a pound of beef free 
from fat, tendons, etc., and digest with a pint of cold 
water for two hours. Let it simmer on the stove for 
three hours at a temperature never above 160° F. Re- 
place the water lost by evaporation by adding coid water, 
so that a pint of beef tea shall represent a pound of beef. 
Strain and carefully express all fluid from the beef. — 

Beef Tea with. Oatmeal.— Mix thoroughly one 
tablespoonful of groats with two of cold water; add to 
tiiis a pint of boiling beef tea. Boil for ten minutes, 
stirring constantly, and strain through a coarse sieve. — 

Beef Tea, Flavored.— Beef tea may be flavored 
agreeably by boiling in it a pinch of mixed herbs, a bay- 
leaf, or a bit of onion, carrot, turnip, or celery and a few 
peppercorns. The roots should either be chopped small 
or be scraped to a pnlp before being added to the broth. 


Beef Jnice. — Broil quickly pieces of the round or 
sirloin of a size to fit the opening in a lemon squeezer. 
Both sides of the beef should be scorched quickly to 
prevent the escape of the juices, but the interior should 
not be fully cooked. As soon as they are ready the 


pieces of meat should be squeezed in a lemon squeezer 
previously heated by being dipped in hot water. As it 
drips the juice should be received into a hot wineglass; 
it should be seasoned to the taste with salt and a little 
Cayenne pepper, and taken while hot. — {Bartholow) 

Cold Beef Juice. — Cover one pound of finely chopped 
lean beef with eight ounces of cold water and allow it to 
stand for eight or ten hours. Squeeze out the juice by 
means of a muslin bag ; season with salt or sherry wine 
and drink cold or slightly warmed. It may be added to 
milk, care being taken that the milk be not too hot before 
the juice is added. 

Iced Meat Extract. — Cut into pieces the size of a 
hand one kilo of fresh beef; wrap in a coarse, lattice- 
like linen bag, put under a lever press, and press slowly. 
The juice should be caught in a porcelain dish. This is 
done best by a druggist. By this method about 500 gm. 
of juice are obtained. The juice is mixed with 250 gm. 
of sugar, 200 gm. of freshly expressed lemon juice (this 
last is best omitted in the case of dyspeptics), and 20 
gm. of cognac containing vanilla extract ; stir in well the 
yolks of three eggs ; the entire mixture is then placed 
in a freezer. — {v. Zicmssen') 

Raw-meat Juice. — Add to finely minced rump steak 
cold water, in the proportion of one part of water to four 
parts of meat. Stir well together, and allow it to stand 
for half an hour. Forcibly express the juice through 
muslin, twisting it to get the best results. — {Chcad/e) 

Succus Camis (Meat Juice). — Cut up the meat into 
small bits, arrange in layers separated from one another 
by coarse linen, and then place in a powerful press. From 
each kilogram of meat about 230 gm. of a blood-red 
juice are obtained. This contains about 6 per cent, of 


albuminates. Its taste is similar to that of raw meat ; 
its flavor may be improved by the addition of salt and 
beef tea not hot enougji to coagulate the albumin. — 
{Pcttenkoffer and Voit.) 

Beef Bsseuce. — Chop up very fine a pound of lean 
beef free from fat and skin ; add a little salt, and put into 
an earthen jar with a lie! ; fasten up the edges with a thick 
paste, such as is used for roasting venison in, and place 
the jar in the oven for three or four hours. Strain through 
a coarse sieve, and give the patient two or three table- 
spoonfuls at a time. — ( Yco^ 

American Bouillon (American Broth). — Place in 
a tin vessel that can be sealed hermetically alternate layers 
of finely minced meat and vegetables. Seal it, and keep 
it heated in a water bath (bain marie) for six or seven 
hours, and then express the broth.— (Ku) 

Bottle Bouillon. — Cut beef, free from fat, into 
squares. Place these in a stoppered bottle, put the 
bottle in a basin of warm water, heat slowly, and boil 
for twenty minutes. There will be about an ounce of 
yellowish or brownish fluid for each three-quarters of a 
pound of meat used. The flavor is that of concentrated 

Peptonized Oy8teT8. — To half a dozen oysters with 
their juice add half a pint of water and boil for a few 
minutes. Pour off the broth and set it aside. Mince 
the oy.sters, and with the aid of a potato-masher reduce to 
the consistence of a pa.ste. Place this with the broth in 
a glass jar and add fifteen grains each of extract of pan- 
creas and of bicarbonate of soda and mix. Allow this 
to stand in hot water (115° F.) for one and one-half 
hours. Pour into a saucepan and add half a pint of milk ; 
heat over a slow fire to boiling-point. Flavor with salt 





and pepper and serve hot. Let the heating be done 
gradually, and be careful to bring the mixture to a boil 
before taking it from the fire. — {^Fairchild.) 

Peptonized Beef.— Cover one-fourth of a pound of 
finely minced lean beef (or beef and chicken mixed) with 
half a pint of cold water. Cook over a slow fire until it 
has boiled for a few minutes, stirring constantly. Pour 
off the broth and rub or pound the meat to a paste. 
Put meat and broth and half a pint of cold water in a 
glass jar, and add twenty grains of extract of pancreas 
and fifteen grains of bicarbonate of soda. Mix well and 
keep in a warm place — at about i lo"-! 15° F. — or place 
it in warm water and allow it to stand three hours, stir- 
ring or shaking occasionally. Boil quickly; strain or 
clarify with the white of an egg and season with salt and 
pepper. If desired, it need not be strained, as the small 
particles of meat are usually easily digested. Cereals 
may be added, boiling with half the amount of water 
previously directed, and mixing all together before pep- 
tonizing. At the end of three hours the mixture must 
be boiled or it will spoil. — {FaiW/ii/t/.) 


Meat given raw should always be perfectly fresh and 
very finely divided. Scrape the meat with a sharp knife, 
which will separate the coarser fibers. If the resulting 
mass is stringy, pass through a fine sieve. This may be 
seasoned with salt and pepper, and served on toast, 
crackers, or bread and butter. It may be rolled into 
small balls and swallowed. These may be flavored as 
de.sired. They may also be slightly browned by rolling 
about rapidly in a hot saucepan, care being taken not to 
change any but the outside of the ball, and that but 


slightly. Scraped beef may be served as a liquid or 
semi-solid food. Mix it with an equal quantity of cold 
water until it is quite smooth. Place in a double boiler 
and cook until thoroughly heated, sdrring constantly. 
Add a little salt and pepper and serve at once. This 
may be made thicker by adding less water. 

Raw Meat with Milk and Sugar.— Scrape half a 
pound of rump steak with a knife until all the pulp is 
removed ; sweeten with sugar, breaking the lumps of 
sugar with the meat in a basin with a small wooden 
spoon. Add slowly as much milk as will make it about 
the thickness of arrowroot ; flavor with brandy. If any 
fiber of the meat remains, strain through a gravy strainer. 
The mixture should be perfectly smooth. — [Ringer^ 

Raw-beef Soup. — This is made by chopping up 
one pound of raw beef and placing it in a bottle with 
one pint of water and five drops of strong hydrochloric 
acid. This mixture is allowed to stand on the ice over- 
night, and in the morning the bottle is placed in a pan 
of water at 1 10° F., and kept at about this temperature 
for two hours. It is then placed in a stout cloth and 
strained until the mass that remains is almost dry. The 
filtrate is given in three portions daily. If the taste of 
the raw meat is objectionable, the meat may quickly be 
roasted on one side and the process completed in the 
manner previously described. — ( Weir Mitchell.) 


Iced Panopepton.— To a small glass half full of 
clean crushed ice add one tablcspoonful o^ Panopepton ; 
let this stand for a minute and then sip slowly. 

Panopepton Jelly.— This is made of one ounce of 
fresh celery cut into small pieces, one-half of a smalt box 


of the best gelatin, one-fourth of a tcaapoonful of salt, 
two dashes of pepper, six tablespoonfuls of Panopcpton, 
and two cupfuls of cold water. Soak- the gelatin in half 
a cupful of cold water for one hour ; put the water and 
celery in a double boiler on the fire and simmer for one- 
half hour; add the salt, pepper, and soaked gelatin and 
stir until it is dissolved ; remove from the fire and add 
the Panopepton ; stir and strain through linen into a 
jelly bag and set near ice. Serve in small quantities. 

Panopepton Jelly with Orange. — The articles 
required are one-half of a small box of the best gelatin, 
one tablcspoonful of sugar, six tablespoonfuls of Paiio- 
pip/d/i, the juice and rind of one orange, and one pint 
of cold water. Put the gelatin, orange peel {cut in small 
pieces), orange juice, and cold water in a dish and let it 
stand for one hour, then put in a double boiler over the 
fire, add the sugar, and stir until it is dissolved ; now 
strain through linen, add the Panopepton, and stir well. 
Pour into a jelly jar and set near the ice. Serve in small 

Panopepton Hot. — To a small teacup two-thirds 
full of boiling water add one tablcspoonful of Panopcp- 
lon and one teaspoonful of fresh iemon juice ; a little 
sugar may be added if desired. Stir and drink immedi- 
ately, sipping slowly. 

Panopepton Bouillon Hot. — Put one tablcspoon- 
ful of Panopepton in a small teacup; fill the cup nearly 
full of boiling water, and flavor to taste with celery salt 
or plain salt and pepper; stir and sip slowly. 

Panopepton Cordial. — Put into a cordial glass or 
any small glas.s two tcaspoonfuls of clean crushed ice; 
add one teaspoonful of Fairchild's Essence of Pepsm and 
three teaspoonfuls of Panopepton. Sip slowly. This x?, 

k— A. 

KEC/FES. 317 

a. good after-dinner cordial for those who suffer discom- 
fort after eating. 

Panopepton with Whey.— Put into a small teacup 
one or two teaspooiifuls of clean crushed ice; add one 
tablespoonful of Panopepton, stir, and then fill the cup 
with whey. Drink slowly. 

Egg Gruel. ^Take one cupful of hot beef broth 
made with " Soluble Reef," one egg, and one-half tea- 
spoonfu! of salt. Beat the white and the yolk of the 
egg separately ; add the hot beef broth gradually to the 
yolk, stirring continually. Whip the white to a stiff, dry 
froth with the salt, and beat it into the hot broth. Return 
to the double boiler and reheat. Serve very hot. 

Barley Gruel with Beef Extract.— One-half tea- 
spoonful of " Soluble Beef," two cupfuls of hot water, 
one tablespoonful of barley flour, one saltspoonful of 
salt. Dissolve the beef in the hot water, and mix the 
flour and salt together with a little cold water. Pour 
the boiling stock on the flour and cook for ten minutes. 
Strain and serve very hot. 

Beef Broth with Poached Egg. — Prepare the 
broth in the proportion of half a teaspoonftil of " Solu- 
ble IJeef " to one cupful of hot water and add a poached 

A Nutritive Drink for Delicate Women and 
Children. — This is made by mixing one-fourth to one- 
half teaspoonful of "Soluble Beef," five ounces of boil- 
ing water, and one-half ounce of cream ; season with 
salt and pepper to suit the taste. 

Beef Broth with Grain.— Take one teaspoonful of 
"Soluble Beef," one quart of water, one tablespoonful 
of rice, and salt to taste. Dissolve the "Soluble Beef" 
in the hot water, and add the well-washed rice. Simmer 

! 3'8 DlliTETICS fUK NURSES. ^B 

slowiy until dissolved and absorbed by the rice, adding 
I more beef broth if too much boils away. If not entirely 

\ dissolved, the broth should be strained before using. 

] Beef-tea Egg-nog.— This requires one-eighth tea- 

I spoonful of "Soluble Bucf," one-half cupful of hot water, 

I one tablespoonfu! of brandy, and a pinch of salt. Beat 

i the egg slightly, and add the salt and sugar. Dissolve 

;, the " Soluble Beef" in the hot water, add to the egg, and 

strain. Mix thoroughly, adding wine, and serve. 


Chicken Jelly. — Half a grown chicken should be 

well pounded, and boiled in one quart of water for two 

hours until only a pint remains; season and strain. 

Serve hot or place on ice, where it will " jel." 

Veal-bone Jelly. — Place ten pounds of veal bones 
and ten quarts of water or weak bouillon over the fire 
and bring to just a boil. Skim and add two pounds of 
barley and a little .salt. Simmer for five or six hours and 
then .strain. If too thick, dilute, before serving, with 
bouillon. Stir in the yolk of an egg in a cup and serve. 
Meat Jelly. — This is made by cooking good bone- 
less, lean beef on a water bath with a little water for 
sixteen hours or until it becomes gelatinized. Of the 
artificial preparations on the market for making bouillon, 
the most reliable is Liebig's Extract of Meat (lo : 250 
gm.) or Cibil's Bouillon (i teaspoonful to 250 gm.). 
InagHo's bouillon capsules are also very convenient If 
it is desired to make the bouillon more nutritious, one 
li teaspoonful of meat peptone may be added. — {Ht-pp^ 

I Jelly for Dyspeptics.— Remove the skin and meat 

I from one calf's foot ; wash the bones and place in cold 

^ water on the stove ; when it begins to foam, skim off the 



refuse which gathers on top. After rinsing off the 
with cold water, put the bones into a pot 
kilo of beef or half an old hen, one-quarter hter of water, 
and 5 gm. of salt, and boii slowly for from four to five 
hours. Pour the jelly thus formed through a fine sieve, 
and place overnight in a cellar. Next morning remove 
the fat, and clarify the cold jelly by adding one egg with 
its shell mashed, beating and stirring steadily. Then, 
with the addition of a little cornstarch, subject the whole 
to a temperature not over 60° R., or the white of the 
egg will curdle. Constantly beat and .stir. If the jelly 
begins to get grainy, cover and let it cool until the white 
of the egg becomes flaky and separates. Then strain 
again several times until it becomes perfectly clear ; add 
5 gm. of extract of meat, pour the jelly into a mold, and 
let it cool again. The gravy from a roast may be utilized 
and is very palatable. It must be stirred in while the 
ma.s3 is still warm and liquid. This jelly is usually relished 
with cold fowl, but spoils easily in summer; it must there- 
fore be kept on ice. — ( Weil.) 

Dishes Made with Gelatin. — Gelatin should be 
soaked in cold water for about half an hour to soften it. It 
may then be easily dissolved by adding boiling water. If it 
is desired to soften gelatin quickly, it should be placed in 
cold water and gradually heated over boiling water until it 
dissolves. If a jeily is to be strained, a wet cloth should 
be used for the purpose. Jelly molds should be wet with 
cold water before being filled. When granulated gelatin 
is used, much smaller amounts are required than when 
the ordinary form is used. 

Wine Jelly. — Soak a teaspoonful of granulated gela- 
tin in two tablespoonfuls of cold water and half a cupful of 
hot water. Add two tablespoonfuls of sugar and half a 

319 ^^ 

the scum ^H 

e-quarter ^| 



tcaspoonful of lemon juice, and when cooling add two 
tablcspoonfuls of wine. — {Drexel Institute^ 

I/emon jelly is made in the same manner as the wine 
jelly just described, using a tablespoonful of lemon juice 
in place of the quantity directed. 

Otang^e jelly is made in a similar manner, using two 
teaspoonfuls of lemon juice, four tablcspoonfuls of orange 
juice, and three tablcspoonfuls of sugar, but a little less 
of the boiling water. 

Coffee jelly is also made similarly, adding an ounce 
or two of coffee. 

Milk Jelly. — Take two quarts of milk and add half 
a pound of sugar. Boil for five or ten minutes. Cool, 
and add an ounce of gelatin dissolved in a cupful of cold 
water. Flavor with the juice of two or three lemons and 
three glasses of good Bordeaux wine. — {Schlesinger^ 

Irish-moss Blanc-mange. — Wash a tablespoonful 
of Irish moss in several changes of water and pick it over 
carefully. Place it in a double boiler together with half 
a cupful of milk. Cook until it thickens when dropped 
on a cold plate. Add salt, strain, and flavor. Pour into 
a custard cup that has first been rinsed in cold water. — 
(Prcxcl Institute) 

Meat Jellies with Gelatin. — Use any kind of 
meat broth desired, but always one with an appetizing 
flavor. Add a tcaspoonful of granulated gelatin to enough 
broth to cover it, and allow the gelatin to soak for a few 
minutes. Then add the remainder of a cupful of the 
broth very hot and stir until the gelatin is dissolved. 
Strain, and pour into molds to cool. 

Meat Jellies with Tapioca. — Mix a cupful of 

broth as above with four level tablcspoonfuls of pow- 
dered tapioca. Heat until quite clear, stirring con- 

stantly. Add salt and . 
molds and cool. 

Meat Jellies with Irish Moss. — Wash two table- 
spoonfuls of Irish moss thoroughly. Add this to a cup- 
ful of hot broth and allow it to stand for half an hour ; 
then heat slowly, stirring constantly, and boil for ten 
minutes, preferably in a double boiler. Strain, and pour 
into molds and cool. 

Albtuninized Jelly. — Any of the above meat jellies 
may be rendered more nutritious by the addition of the 
white of an egg. The egg should be well beaten and 
stirred into the jelly just after it has been taken off the 


Glnteo Bread. — Mix one pound of gluten flour 

with three-fourths of a pint or one pint of water at 
F. (With some of the prepared flours — Bishop's, for 
example— no yeast is required.) As soon as the dough 
is mixed put it into tins and place them immediately in 
the oven, which should be at a temperature of about 
430° F. Or the dough may be made into small dinner 
rolls and baked on flat tins. The loaves take about one 
and one-half hours to bake, and the rolls three-fourths 
of an hour. Either are easily made. The addition of a 
little salt improves the bread. 

IV/ien any special brand of flour is used, the directions 
that accompany it should be followed closely. 

Gluten Ptidding. — A batter of eggs, cream, and 
gluten flour is prepared. This is flavored with lemon 
or other e.ssences and baked. 

Glnten Pancakes. — Add gluten flour to one or two 
eggs and beat into a batter. The pancakes may be 


sweetened with a little saccharin or eaten with glycerin. 
( Williamson^ 

JeflBries' Gluten Biscoit. — Mix thoroughly gluten 
flour, one cupful; best bran, previously scalded, one 
cupful ; baking-powder, one teaspoonful ; salt to taste ; 
two eggs ; milk or water, one cupful. 

Diabetic Bread. — ^Take one quart of set milk or 
milk and water, one heaping teaspoonful of good butter, 
one-fifth of a cake of compressed yeast beaten up with 
a little water, and two well-beaten eggs. Stir in gluten 
flour until a soft dough is formed ; knead as in making 
ordinary bread ; place in pans to raise, and when light 
bake in a hot oven. — {James Stewart) 

Camplin's Bran Cakes. — ^Take a sufficient quan- 
tity — say a quart — of wheat bran, boil it in two succes- 
sive waters for a quarter of an hour, each time straining 
it through a sieve ; then wash it well with cold water (on 
the sieve) until the water runs off perfectly clear ; squeeze 
the bran through a cloth as dry as possible, and then 
spread it thinly on a dish ; place it in a slow oven ; if 
put in at night, let it remain until the morning, when, 
if perfectly dry and crisp, it will be ready for grinding. 
The bran thus prepared must be ground in a mill, and 
sifted through a wire sieve that has so fine a mesh that 
a brush must be used to pass it through ; that which 
remains in the sieve must be reground until it becomes 
quite soft and fine. Take of this bran powder three 
ounces (some patients use four ounces); the other in- 
gredients are as follows : three new-laid eggs ; one and 
one-half or, if desired, two ounces of butter ; about half 
a pint of milk. Mix the eggs with a little of the milk, 
and warm the butter with the remainder ; then stir the 
whole well together, adding a little nutmeg or ginger or 


any other agreeable spice. Bake in small tins (patty 
pans), which must be well buttered, in a somewhat quick 
oven for about half an hour. When baked, the cakes 
should be a little thicker than a captain's biscuit ; they 
may be eaten with meat or cheese for breakfast, dinner, or 
> supper. At tea they require a somewhat liberal allow- 
ance of butter, or they may be eaten with curd or with 
any soft cheese. It is important that the flour be pre- 
pared as directed above. If the cakes do not keep well 
or if they have not been well prepared, place them before 
the fire for ten minutes every day. 

Almond Padding.— ^Take two eggs, one-quarter of 
a pound of almond flour, one-quarter of a pound of but- 
ter, and three tabloids of saccharin dissolved in a table- 
spoonful of brandy. Warm the butter, beat in the 
almond flour and the yolks of the eggs, and add the dis- 
solved .saccharin. Whip the whites into a stiff froth, and 
beat all together. Put into dariole molds and bake in a 
quick oven ; serve with a little hot sauce made with dry 
sherry and saccharin. — {Mrs. Hart) 

Almond Bisctdt. — To each ounce of almond flour 
add the whites of two eggs and salt to taste. Whip 
the whites to a stiff froth, add the ahnond flour, and beat 
well together. Put in buttered patty pans and bake in a 
moderately quick oven for from fifteen to twenty min- 
utes. The whole must be done quickly, and baked as 
soon as the ingredients are mixed. This biscuit is a use- 
ful substitute for bread. — {Mrs. Hart) 

Almond Cakes No. i.— Take one'pound of ground 
almonds, four egg.s, two tablcspoonfuls of milk, a pinch 
of salt. Beat up the eggs, and stir in the almond flour; 
place in twelve flat tins and bake in a moderate oven for 
about fifteen minutes. — {Saundby) 



Almond Cakes No. a. — Break up about one-quar- 
ter of a pound of sweet almonds in a stone mortar (or 
almond flour may be used). Put the flour into a linen 
bag, which should then be immersed for one-quarter of 
an hour in boiling water, acidulated with a little vinegar 
to remove the small amount of sugar from the almonds.. 
Mix well with three ounces of butter and two eggs. 
Then the yolks of tJiree eggs and a little salt are added, 
and the whole stirred briskly for some time. Beat the 
whites of three eggs to a fine froth and add to the mixt- 
ure. The paste is then made into biscuits, smeared with 
butter, and baked with a gentle fire. — {Seegen') 

Alenronat Bread. — Take about six or seven ounces 
of ordinary wheat flour and the same quantity of aleu- 
ronat powder; five ounces of the best butter; one tea- 
spoonful of salt; three-quarters of an ounce of baking- 
powder. The flour and the aleuronat are mixed in a 
warm dish, and the melted butter and milk (made luke- 
warm) are added gradually, followed by the salt, and 
finaUy by the baking-powder (one part of sodium carbon- 
ate and two parts of cream of tartar). The dough is 
well mixed, then molded into two loaves, and baked at 
a good Jieat, — (Ehstfhi'.\ 

Aleuronat and Almond Cakes. — Three ounces of 
aleuronat; three ounces of almond flour; beat up one 
egg. and add about two teappoonfuls of cream and a 
little water. Moisten the aleuronat with a little water 
containing saccharin and let it stand for a few minutes ; 
then add the almond flour, the egg, the cream, and the 
' water just as required to make a light paste. Spread on 
a tin. Cut into squares, and bake in a moderate oven 
for twenty minutes. — {Williatiisoit?i 

Aleuronat Pancakes. — Take one egg and beat it 


up in a little water and cream ; take two teaspoonfuls of 
aleuronat powder and half a teaspoonful of baking-pow- 
der and a little salt. Mix well, and then add gradually 
to the egg and cream and beat into a batter; allow it to 
stand for fivi: minutes. If it is too thick, add a little 
more cream and water. Fry in an ordinary frying-pan 
greased with a little lard. At the end of about eight 
minutes, when the under surface is browned, turn it over 
and continue to bake it for five minutes longer. — ((J'/A 

Aleuronat and Suet Pudding. — This is a palatable 
and cheap dish. To make it take two ounces of aleuro- 
nat flour and two ounces of suet, one egg, a pinch of 
salt, and half a teaspoonful of baking-powder. Sprinkle 
a little aleuronat flour on a chopping- board and chop the 
suet on this part of the board. Then mix the remaining 
aleuronat with the suet in a dishpan. Add the salt and 
the baking-powder. Beat up the egg in about three 
tablespoonfuls of water to which a little saccharin has 
been added. Add the egg gradually to this mixture, 
rubbing the whole mass well into a paste. It may be 
necessary to add a little more water. Drop into a tin 
pudding mold smeared with butter or lard, float it in a 
pan of water, and boil for two hours, taking care that the 
boiling water does not get into the mold ; or, better still, 
the pudding may be baked in the oven. Its taste is im- 
proved by the addition of half an ounce of almonds. A 
small quantity of red wine may serve as a sauce. — [Wii- 

Cocoannt Pancakes. — Beat up one egg in two table- 
spoonfuls of milk, or, better, in a little cream and water, 
and add a pinch of salt. Then add two tablespoonfuls 
of cocoanut powder (freed from sugar). Allow this to 


stand for from five to ten nlinutes. Add a little more 
cream and water. Mix well until it is a little thicker than 
ordinary pancake batter. Put a little lard in the fr>'ing- 
pan and heat until the lard is just melted ; then drop in 
half of the mixture. Allow this to remain over a mod- 
erate fire for a few minutes — about five — until the under 
surface is brown ; then turn the cake over and heat for 
another five minutes. The other half of the mixture 
may be used for the second pancake. — {IVilliamson) 

Cocoanut Cakes. — Mix three tablespoonfuls of 
cocoanut powder into a paste with a little German yeast 
and water. The mixture should be allowed to remain 
by the fire or in a warm place for about twenty minutes, 
or until fermentation occurs and it becomes "puffy." 
Then add a small quantity of a watery solution of sac- 
charin. Beat up one ^gg, and add this with two tea- 
spoonfuls of cream and a little water to the cocoanut 
paste. The whole should be well mixed, dropped into 
small tins, and baked in an oven for about thirty min- 
utes. — ( Wi//iamso?i.) 

Cocoanut and Almond Cakes. — To make these, 
the following ingredients are required: Three-quarters 
of a pound of the finest cocoanut powder, one-quarter 
of a pound of ground almonds, six eggs, and half a 
cupful of milk. Beat up the eggs and stir in the cocoa- 
nut and almond flour. Divide into sixteen flat tins, 
and bake for twenty-five minutes in a moderate oven. — 

Cocoanut Pudding. — Take three tablespoonfuls of 
cocoanut powder, mix with a little water and German 
yeast, and keep for twenty minutes in a warm place, so 
as to allow the small quantity of sugar present to decom- 
pose ; add four tablespoonfuls of cream, one egg, a little 


salt, and half a pint of water sweetened with saccharin. 
Mix into a paste. Place in a dish greased with butter. 
Cook like rice pudding, in a slow oven for thirty min- 
utes. — (WiJ/iaiiisii/i.) 

I,ight Custard. — Beat up well one egg; make a 
mixture of cream and water and boil ; gradually add the 
boiled cream and water, while hot, to the egg, stirring 
with a spoon. Then place the mixture in a pan over the 
fire, and stir constantly until it becomes thick ; then 
pour in\o a glass. It is important that the mixture should 
not be heated too much — /. c, that it be not boiled — as 
the albumin would be coagulated. Flavor with cinna- 
mon and sweeten with saxin or saccharin if desired. 

Cheese Cakes. — Take one pint of milk, half a table- 
spoonful of rennet, one ounce of butter, two eggs, one 
table.spoonful of brandy, one-quarter of an ounce of 
almond.s, and a little saccharin. Curdle the milk, and let 
it stand in a warm place until thoroughly set; tie a piece 
of muslin over a bowl and pour the milk over the muslin ; 
let it stand until al! the whey has been strained off. Beat 
the curd smooth, and add the butter and egg, well beaten, 
with the brandy, almonds, and saccharin. When well 
mixed pour into patty pan-s and bake for fifteen or twenty 
minutes. — (Afrs. Ntirf.) 

Stewed I,ettuce. — A well-grown head of lettuce 
.should be selected. Boil this in plenty of water, taking 
care not to let it fall to pieces. When nearly done take 
it out of the water, drain, and place in a stewpan with a 
little rich brown gravy and allow it to simmer for twenty 

Intilin Biscuit. — Put 50 gm. (i| oz.) of inulin in a 
large porcelain basin, place this over a hot-water bath, 
and with 30 c.c. (i oz.) of milk and as much hot water 


as may be necessary, rub up into a smooth dough, into 
which the yolks of four eggs and a little salt have been 
mixed. To this add the whites of the four eggs, having 
first beaten them to a foam, and working them in care- 
fully. Bake in tin molds smeared with butter. The 
taste of the biscuit may be improved by adding vanilla 
or other flavoring extract. Inulin is too expensive to be 
used by the average patient. 

Peanut Plour. — This contains about 25 per cent, of 
carbohydrates. The peanut kernels should be boiled in 
water for half an hour to extract a portion of the oil 
which they contain. They should then be dried, and 
rolled into fine particles with a rolling-pin. Place the 
kernels in boiling water acidulated with tartaric acid 
or vinegar, in order (i) to extract saccharin elements ; 
(2) overcome the taste and odor of the peanut ; (3) to 
prevent emulsification of the remaining oil. When they 
have been thoroughly boiled in acidulated water, the 
ground kernels should be subjected to dry heat and then 
rolled into a fine flour. This flour may be made into a 
form of porridge with milk ; bread and biscuits may also 
be baked from it ; and it may be made into the form of 
a German pancake. — {Sterri) 

Home-made Substitute for Bread. — Beat up thor- 
oughly six eggs ; add a teaspoonful of baking-powder 
or its chemical equivalent, and one-quarter of a teaspoon- 
ful of salt, and beat again. Pour this mixture into hot 
waffle-irons smeared with butter, and bake in a very hot 
oven. By way of variety almonds (powdered) may be 
added. These biscuits may be eaten hot with butter and 

Sugar-free Milk for Diabetic Feeding. — Take 
I liter of skim milk, heat to a temperature of 30° C, and 


add 10 C.C. of glacial acetic acid, diluted with lOO c.c. of 
water. Mix, and allow the mixture to stand for about 
fifteen minutes. Collect the separated casein, and let it 
drain on very fine muslin, using no pressure. Remove 
the casein to a mortar, rub into a smooth paste, add 
I liter of distilled water, and strain as before. Repeat 
this washing of the casein twice. Transfer to a mortar, 
rub until quite smooth, and add 2\ gm. of potassium 
hydrate dissolved in 100 c.c. of water (or as much of the 
potassium hydrate as is necessary to make the product 
just alkaline to phenolphthalein). Add 100 gm. of 
ordinary Devonshire clotted cream, 5 gm. of gelatin, 
previously dissolved, 0.06 gm. (i gr.) of saccharin, and 
water, at about 38° C, up to i liter. Lastly, strain 
through fine muslin. — {Hutchiso?i^ 



The methods of cutting sides of beef, veal, mutton, 
and pork into parts, and the terms used for the diflerent 
" cuts," as these parts are commonly called, vary in 

different localities. The analyses here reported apply to 
cuts as indicated by the following diagrams. These Show 
the positions of the different cuts, both in the live animal 

'This SLClii"! is quulcil from Atwaler ami lirraiit, Bull/lia Ne. aS, 
Office of Kx|».-riiuLu( Stations, fiulccl Stales ))c|Kirlinen( of Agriculture. 



and in the dressed carcass as found in the markets. 
The lines of division between the different cuts will vary 
slightly, according to the usage of the local market, 
even where the general method of cutting is as here 
indicated. The names of ttie 
same cuts likewise vary in 
different parts of the coiintrj-. 
Cuts of Beef.— The gen- 
eral method of cutting up a 
side of beef i.s illustrated in 
Fig. 5, which shows the rela- 
tive position of the cuts in the 
animal and in a dressed side. 
The neck piece is frequently 
cut so as to include more of 
the chuck than is repre.sented 
by the diagrams. The shoul- 
der-clod is usually cut without 
bone, while the shoulder (not 
included in diagram) would 
include more or less of the 
shoulder blade and of the up- 
per end of the fore-shank. 
Shoulder steak is cut from 
the chuck. In many locali- 
ties the plate is made to in- 
clude all the parts of the fore- 
quarter designated on the diagrams as brisket, cross- 
rib.s, plate, and navel, and different portions of the 
plate, as thus cut, are spoken of as the "brisket 
end of plate " and " navel end of plate." This part of 
the animal is largely used for corning. The ribs are fre- 
quently divided into first, second, and third cuts, the 


latter lying nearest the chuck and being slightly less 
desirable than the former. The chuck is sometimes sub- 
divided in a similar manner, the third cut of the chuck 
being nearest the neck. The names applied to different 
portions of the loin vary considerably in different locali- 
ties. The part nearest the ribs is frequently called 
** small end of loin " or " short steak/' The other end 
of the loin is called '* hip sirloin " or " sirloin." Between 
the short steak and the sirloin is a portion quite generally 
called the " tenderloin/' for the reason that the real ten- 
derloin, the very tender strip of meat lying inside the 
loin, is found most fully developed in this cut. Porter- 
house steak is a term most frequently applied either to 
the short steak or the tenderloin. It is not uncommon 
to find the flank cut so as to include more of the loin 
than is indicated in the figures, in which case the upper 
portion is called " flank steak." The larger part of the 
flank is, however, very frequently corned, as is also the 
case with the rump. In some markets the rump is cut 
so as to include a portion of the loin, which is then sold 
as " rump steak." The portion of the round on the 
inside of the leg is regarded as more tender than that 
on the outside, and is frequently preferred to the latter. 
As the leg lies upon the butcher's table, this inside of 
the round is usually on the upper or top side, and is 
therefore called " top round." Occasionally the plate is 
called the " rattle." 

Cuts of Veal. — The method of cutting up a side of 
veal differs considerably from that employed with beef 
This is illustrated by Fig. 6, which shows the relative 
position of the cuts in the animal and a dressed side. 
The chuck is much smaller in proportion, and frequently 
no distinction is made between the chuck and the neck. 



The chuck is often cut so as to include considerable 
of the portion here designated as shoulder, following 
more nearly the method adopted for subdividing beef. 
The shoulder of veal as here indicated includes, besides 
the portion corresponding to the shoulder in beef, the 
larger part of what is here classed as 
chuck in the adult animal. The under 
part of the fore-quarter, corresponding 
to the plate in the beef, is often desig- 
natetl as breast in the veal. The part 

of the veal corresponding to the rump of beef is here 
included with the loin, but is often eut to form part of 
the leg. In many localities the fore- and hind-shanks of 
veal arc called the " knuckles." 

Cuts of I^amb and Mutton. — Fig. 7 shows the 
relative position of the cuts in a dressed side of mutton 
or lamb and in a h've animal. The cuts in a side of lamb 
and mutton number but six, three in each quarter. The 





chuck includes the ribs as far as the end of the shoulder 
blades, beyond which comes the loin. The flank is made 
to include all the under side of the animal. Some 
butchers, however, make a large num- 
ber of cuts in the fore-quarter, including 
a portion of the cuts marked " loin " 
and ** chuck " in Fig. 7, to make a cut 
designated as " rib," and a portion of 
the "flank" and "shoulder" to make 
a cut designated as "brisket." The 
term " chops " is ordinarily used to 
designate portions of either the loin, 

Fig. 7. — Diagrams of cuts of Iamb and mutton: i. Neck; 2, chuck; 3, shoulder ; 
4, flank; 5, loin ; 6, leg.— (Atwater and Bryant, Bulletin No. 28, Office of Experi- 
ment Stations, United States Department of Agriculture.) 

ribs, chuck or shoulder, which are either cut or 
" chopped " by the butcher into pieces suitable for 
frying or boiling. The chuck and ribs are sometimes 
called the " rack." 

Cuts of Pork. — The method of cutting up a side 
of pork differs considerably from that employed with 
other meats. A large portion of the carcass of a 
dressed pig consists of almost clear fat. This furnishes 


the cuts which are used for " salt pork " and bacon. Fig. 
8 illustrates a common method of cutting up pork, show- 

ing the relative position of the cuts in the animal and in 
the dressed side. The cut designated as " back cut " is 
almost clear fat, and is used for 
salting and pickling. The " mid- 
dle cut " is the portion quite gen- 
erally used for bacon and for " lean 
ends " of salt pork. The belly is 
salted or pickled or may be made 
into sausages. 

Beneath the "back cut" are the 
ribs and loin, from which are ob- 
tained " spare ribs," " chops," and 
roasting-pieces, here designated by 
dotted lines. The hams and shoul- 
ders are more frequently cured, but 
arc also sold as fresh pork " steak." 
The tenderloin proper is a com- 
paratively lean and very small strip 
of meat lying under the bones of 
the loin and usually weighing a 
fraction of a pound. Some fat is 


usually trimmed off from the hams and shoulders, which 
is called " ham and shoulder fat/' and is often used for 
sausages, etc. What is called " leaf lard," at least in 
some localities, comes from the inside of the back. It 
is the kidney fat. 

As stated above, cuts as shown in the diagrams here- 
with correspond to those of which analyses are reported 
in the tables beyond, but do not attempt to show the 
different methods of cutting followed in markets in differ- 
ent parts of the United States. 


Relative Values of Apothecaries' and Metric 

Fluid Measures. 

Minims, centi- 



Fluid- ^_ 

iri..;j Cubic 
^*"**^- centi- 



ounces. ^^.^^ 

°""<=«- meters. 

I = 0.06 

30 - 


I = 30.00 

21 = 621.00 

2 = 0.12 

35 - 


2 = 59.20 

22 = 650.00 

3 -= 0.18 

40 = 


3 = 89.00 

24 = 710.00 

4 = 0.24 

45 = 


4 = 118.40 

25 = 740.00 

5 - 030 

50 ^ 


5 = 148.00 

26 = 769.00 

6 = 0.36 

55 =- 


6 = 178.00 

27 = 798.07 

7 = 0.42 

7 = 207.00 

28 - 828.80 

8 = 0.50 


8 = 236.00 

30 = 887.25 

9 =-- 0.55 


9 = 266.00 

31 =-- 917.00 

10 -= 0.60 

I ^ 


10 = 295.70 

32 -= 946.00 

II = 0.68 



12 = 355CO 

48 = 1419.00 

12 = 0.74 



13 = 38500 

56 = 1655.00 

13 --= 0.80 

134- -.- 


14 = 414.C0 

64 = 1892.00 

14 0.85 

2 - 


15 = 444.C0 

72 =- 2128.00 

15 - 0.92 

3 - 


16 - 473." 

80 =- 2365.00 

16 = 1. 00 

4 - 


17 = 503C0 

96 = 2839.00 

17 - 1.05 

5 --^ 


18 = 532.00 

112 = 3312.00 

18 - 1. 12 

6 - 


19 = 591.50 

128 = 3785.00 

19 - I 17 

7 = 


20 --■ 1.25 

25 - 1-34 

Relative Values of Metric Fluid and Apothecaries* Measures. 











I COO -= 


4CO = 


900 --- 


3CO - 


8co - 


200 ^■ 


700 = 


100 -= 


6co = 


75 - 


500 = 


50 ^ 


473 - 


30 - 


C"^!«^ Fluid- 









Relative Values of Avoirdupois and Metric Weights, 

A^«"- Grams. ^'"^^' 
ounces. ounces. 

Grains. ! ^^"^- 



h = 1-772 
Vi, -= 3-54t 

- 5 -■- 141 75 

13 ^ 


6 = 170.10 

14 --- 


5^ = 7.088 

7 -- *98 45 

15 ~- 

425 25 

'A ^ 14*75 

8 -= 226.80 


I = 28.350 

9 = 255-15 


2 = 56.700 

10 — 283.50 

I.O - 


3 = 85.050 

II =311.84 

2.0 =- 


4 -113-400 

12 — 340.20 

2.2 — 

















4535 92 

Relati7'c Values of Metric and Avoirdupois Weights, 

Gm Ounces. Gr. 

Gm. Ounces, (ir. Gm. Ounces. Gr. j Gm. Ounces. Or. 

28.35 = 



- I + 

'1^ 1 

125 = 4 + 179 


= 21+73 

29.00 ^- 




- I + 

164 ! 

150 —- 5 + i-«7 


= 22+405 

30.00 = 


25 40 

■= 1 + 


200 —7+24 


= 24 + 303 

32.00 = 


56 50 

- I + 


250 - 8 + 358 


3300 = 




--- 2 + 


300 .-- 10 4- 255 


= 28+96 

34.00 -^ 




- 2 + 


350 — 12 + 152 



35-00 — 




- 2 + 

300 , 

400 --- 14 + 48 


= 31 + 326 

36.00 -^ 




■■ 3 


500 = 17 -f- 279 


= 33 + 222 

37.00 = 





--- 3 + 

s of Aj 


23P 550 = 19 - 

bothecaries' and 

v 175 

■ Drar 




've Value 


ic Weights, 

















































































































. : 



















1. 0000 















- - 

1. 1600 









I 3000 









1 .3600 1 










)0 : 









Relative Values of Metric and Apothecaries' Weights. 

































2374 85 

















Absorption, i6 
of beans, 25 
of carbohydrates, 23 
of cereals, 25 
of eggs, 24 
of fats, 23 
of fish, 24 
of foods, 22 
of fruits, 25 
of green vegetables, 25 
of legumes, 25 
of meat, 24 
of milk, 24 
of peas, 25 
of protein, 23 
of rice, 25 
of roots, 25 
of tubers, 25 
of vegetables, 24 
green, 25 
Acid wines, 78 
Acids in urine, 76 
Acne, diet in, 271 
Acratothermal waters, 70 
Actinomycosis, 91 
Adulteration, food, 92 
accidental, 92 
arbitrary, 92 
conventional, 92 
incidental, 92 
intentional, 92 
preservatives in, 94 
table of, 93 
of milk, 34 

Age, food and, relation, 18 
Aged, diet for, 133, 134 
Air-exclusion in preserving food, 81 
Albumin water, 286 
Albuminized jelly, 321 

lemonade, 287 

milk, 303 
Albuminoids, 12 
Alcohol, 72 

digestibility of, 74 

food value of, 72 

fuel value, 74 

in genito-urinary diseases, 232 

in injury to alcoholics, 244 

in tuberculosis, 173 

in typhoid fever, 160 

in urine, 76 

wood, as adulterant, 94 
Alcoholics, illness in, alcohol and, 

Alcoholism, diet in, 243 
Ale, 76 
Aleuronat, 84 

and almond cakes, 324 

and suet pudding, 325 

bread, 324 

in diabetes mellitus, 257 

pancakes, 324 
Algne. 59 

Alkaline mineral waters, 69 
Almond and cocoanut cakes, 326 

biscuit, 323 

bitter, junket, 301 

cakes, 323, 324 




Almond cakes and aleuronat, 324 
in diabetes mellitus, 257 

milk, 285 

pudding, 323 
Almonds, 59 
American bouillon, 313 

broth, 313 
AmcEba coli in water, 91 
Amylopsin, 16 
Anemia, diet in, 230 
Anesthesia, diet and, 274 
Aneurism, diet in, 230 
Angina pectoris, diet in, 230 
Animal foods, 32 

table of compositions, 48 
Antiseptics to preserve food, 82 
Apoplexy, diet in, 242 
Apothecaries' and metric fluid meas- 
ures, relative values, 337 

and metric weights, relative values, 

Appendicitis, diet in, 209 
Appetite, digestion and, influence on, 

Apple water, 286 
Apples, 57 
Army enema, 143 
Arnold sterilizer, 39 
Aromatic wines, 78 
Arrowroot gruel, 290 
Arthritis deformans, diet in, 264 
Artificial feeding of child, 100 

foods, 83 

proprietary foods, 84, 85 
Ascaris lumbricoides in food, 92 
Asparagus, 56 
Ass's milk, composition, 33 
Asthma, diet in, 222 
Asylums, infant, feeding in, 123 
Atonic dyspepsia, diet in, 194 
Atwater's table of coefficients of 
digestibility, 23 
of food requirements at diff"erent 
ages, 18 

Atwater's table of fuel value of foods, 
of nutritive ingredients of food, 

Avoirdupois and metric weights, rela- 
tive values, 338 

Bacon, 47 

composition, 48 
Baking meat, 87 
Bananas, 57 
Bauer's method of milk modification, 

Banting diet for obesity, 268 
Barley gruel, 290 

with beef extract, 317 
jelly, 292 
water, 288 
Barlow's disease, diet in, 265 
Beans, 56. 54 

absorption of, 25 
Beef, 45 
broth, 309 

with grain, 317 
with poached ^gg, 317 
composition, 48 
cuts of, 331 
essence, 313 
extracts, 46 

barley gruel with, 317 
soup stock from, 308 
juice, 45, 46, 311 

cold, 312 
meal, 46 

mosquera, 83 
peptonized, 314 
raw, preparing, 314 

soup from, 315 
tea, 310 

egg-nog, 318 
flavored, 311 
with oatmeal, 311 
Beer, 71 
Beet, 55 



Beriberi, 91 
Berries, 58 
Beverages, 66, 285 
Biliousness, diet in, 218 
Biscuit, almond, 323 

inulin, 327 

Jeffries' gluten, 322 
liitter almond junket, 301 

waters, 70 
Bitters, 75 

Bladder, stone in, diet in, 234 
Blanc-mange, Irish-moss, 320 
Blood-vessels, dilation of, diet in, 230 
Boas' enema, 143 
Boiling meat, 86 
Bomb calorimeter, 14 
Bone-marrow, 65 
Bottle bouillon, 313 
Bottle-feeding, beginning, 108 
l^otulismus, 90 
Bouillon, 45 

American, 313 

bottle, 313 

panopepton, hot, 316 
Bovine tuberculosis, milk contamina- 
tion in, 37 
Bowels, care of, after operations, 279 
Brain operations, diet after, 277 
Braising meat, 87 
Bran bread in diabetes mellitus, 257 

cakes, Camplin's, 322 
Brandy, 75 
Brandy-and-egg mixture, 285 

for infants, 285 
Bread, 52, 293 

aleuronat, 324 

bran, in diabetes mellitus, 287 

brown, 294 

diabetic, 322 

Drexel Institute recipe, 293 

gluten, in diabetes mellitus, 256 
recipe for, 321 

nut-brown, 294 

pulled, 294 

Bread, substitute for, home-made, 328 
in diabetes mellitus, 256 

Soya, in diabetes mellitus, 256 

torrified, in diabetes mellitus, 256 

whole-wheat, 294 
Breast-feeding, 95 

contra-indications, 99 

frequency, 97 
Breasts, care of, 95 
Brisket end of plate, 331 
Broiling meat, 88, 307 

pan, 307 
Broth, American, 313 

beef, 309 

with grain, 317 

with poached ^^'g, 317 

chicken, 309 

clam, 310 

^Zg, 286 

meat, 309 

mutton, 309 

without meat, 310 
with vegetables, 310 

veal, 310 
Brown bread, 294 
Buccal digestion, 15 ' 
Buffalo's milk, composition, 33 
Butter, 35 
Butterine, 65 
Buttermilk, 36 

Cabbages, 55 

Calcium salts, 66 

Calculous affections, diet in, 234 

Calorie, definition, 14 

gram, 14 
Calorimeter, bomb, 14 
Camplin's bran cakes, 322 
Candy, 63 
Cane-sugar, 62 
Canning food, 82 
Carbohydrate-free diet in diabetes 

mellitus, von Noorden's, 254 
Carbohydrates, 13 



Carbohydrates, absorption of, 23 

fuel value of, 14 

in stomach diseases, 185 

in typhoid fever, 158 

of vegetables, 51 

proteins, and fats in combination, 
quantity required, 27 

quantity required, 26 

uses of, 14 
Carcinoma of stomach, diet in, 199 
Carrots, 55 

Catarrh, intestinal, acute, diet in, 205 
chronic, diet in, 206 

with constipation, diet in, 206 
with diarrhea, diet in, 206 
Cat's milk, composition, 33 
Catsup, 64 
Caudle, 286 
Celery, 56 

soup, cream of, 297 
Cereal-and-milk waters, 303 
Cereals, 52, 289 

absorption of, 25 

composition of, 60 

cooking, 289 

length of time, 290 

foods from, with starch not predi- 
gested, 85 

gruels from, 289 

in tuberculosis, 172 

partially digested, prepared at ta- 
ble, 292 
Cheese, 36 ' 

cakes, 327 
Cheese-poisoning, 90 
Chemicals in preserving food, 82 
Chemistry of digestion, 11 
Chestnut pur^e, 293 
Chestnuts, 59 
Chickens, 47 

composition, 48 

broth, 309 

jelly, 318 
Chick-pea, poisoning from, 91 

Children, feeding of, 95 
Chocolate, 72 
Cholelithiasis, diet in, 220 
Chops, mutton, 334 

pork, 335 
Chorea, diet in, 241 
Cider, 79 
Cinnamon, 64 

Cinnamon-and-milk drink, 303 
Circulatory diseases, diet in, 225 
Clam broth, 310 

juice, 310 
Clams, 50 

composition, 49 
Cleft palate operation, diet after, 277 
Climate, food and relation, 18 
Cloves, 64 
Cocoa, 72 

junket, 300 
Cocoanut, 59 

and almond cakes, 326 

cakes, 326 

in diabetes mellitus, 257 

pancakes, 325 

pudding, 326 
Cod-liver oil, 65 
Coefficients of digestibility of foods, 

Coffee, 71 

effect, 171 

jelly, 320 

junket, 301 

preparation, 71 
Cold egg-nog, 286 

in preserving food, 82 
Colic, 124 
Colostnim, 95 
Coma, diabetic, 256 
Concentrated food, 80 
Condensed milk, 43 
Condiments, 63 

Constipation, chronic, dietetic treat- 
ment, 212, 214 

in atonic dyspepsia, diet in, 195 



Constipation in children, diet in, 

with chronic intestinal catarrh, 
in, 206 
Convalescent diet, 283 
Cooking, effect of, 88 

of fish, 88 

of foods, 86 
rapid, 89 

of meat, 86 
effect of, 88 

of vegetables, effect of, 88 
Copper as adulterant, 94 
Cordial, 75 

egg, 286 

panopepton, 316 
Cornmeal gruel, 292 
Cauliflower, 55 

Cow, tuberculous, milk from, 37 
Cows' milk, composition, 33, 34 

foods prepared from, 84 
Crab, 50 

composition, 49 
Cracker gruel, 291 
Crackers, crisp, 296 
Cre\im, 35 

Cream-of-celery soup, 297 
Cream-of-potato soup, 297 
Cream -of-tartar whey, 302 
Cream -of-tomato soup, 296 
Crisp crackers, 296 
Crustaceans, 50 

composition, 49 
Curds, 36, 300 
Currant juice, 287 
Currants. 58 
Custards, baked, 305 

chocolate, 305 

light, 327 

rules for, 304 

soft, 305 

steamed, 305 
Cuts of beef, 331 

of lamb, 333 

of meat, 330 


Cuts of mutton, 333 
of pork, 334 
of veal, 332 

Dates, 58 

Diabetes mellitus, aleuronat in, 257 
almond cakes in, 257 
bran bread in, 257 
bread in, diabetic, 322 

substitutes for, 256 
cocoanut cakes in, 257 
coma in, 256 
diabetic bread in, 322 
diet in, 253 

carbohydrate-free, 254 
prophylactic, 255 
-^ in treatment, 255 

von Noorden's, 254 
foods allowed, 258 
conditionally, 260 
moderately, 259 
especially valuable, 261, 262 
gluten bread in, 256 
recipes for foods in, 321 
Soya bread in, 257 
sugar-free milk for, 328 
torrified bread in, 256 
Diabetic bread, 322 

coma, 256 
Diarrhea, dietetic treatment, 212, 213 
in childhood, 127 

diet in, 128, 129 • 
in older children, 130 
with chronic intestinal catarrh, diet 
in, 206 
Diet after cleft palate operations, 277 
after esophageal operations, 277 
after hare-lip operation, 277 
after laryngeal operations, 277 
after operations, 275 
about face, 277 
about head, 276 
cl(*ft palate, 277 
esophageal, 277 



Diet after operations, hare-lip, 277 

laryngeal, 277 

nausea and, 279 

on Ijrain, 277 

on intestines, 281 

on ki(ln<ry, 280 

on pancreas, 280 

on rrctum, 281 

on stomach, 280 

on various organs, 280 

plastic, 277 

thirst and, 279 

vomiting and, 279 
anesthesia and, 274 
convalescent, 283 
cures, 272 

diseases from errors in, 89 
dry, 222 
during pregnancy, 136 

puerperium, 136 

second year, 109 
factors bearing on, 80 
farinaceous, 283 
for aged, 133 

for child eighteen months to two 
and one-half years, 113 

fifteen to eighteen months old, 

twelve to fifteen months old, iii 

two and one-half to six years of 
age, 114 
for children, 95 
for infants, 95 
for school children, 119 
for sick infants, 124 
full, 283 
hospital, 283 
house, 283 
in acne, 271 
in alcoholism, 243 
in anemia, 230 
in aneurism, 230 
in angina pectoris, 230 
in apoplexy, 242 

Diet in appendicitis, 209 
in arthritis deformans, 264 
in asthma, 222 
in Barlow's disease, 265 
in biliousness, 218 
in calculous affections, 234 
in carcinoma of stomach, 199 
in cholelithiasis, 220 
in chorea, 241 
in circulatory diseases, 225 
in constipation, 212 
chronic, 212, 214 
in atonic dyspepsia, 194 
in children, 131 
in diabetes mellitus, 253 
carbohydrate-free, 254 
foods allowed, 258 
conditionally, 260 
moderately, 259 
especially valuable, 261, 262 
prophylactic, 255 
treatment by, 255 
von Noorden's 254 
in diarrhea, 212, 213 
in childhood, 128, 129 
in older children, 130 
in difficult swallowing, i8o 
in dilation of blood-vessels, 230 
of heart, sudden, 229 
of stomach, 192 
in diphtheria, 167 
in disease, general rules, 145 
in diseases of pregnancy, 137 

of stomach in infants, 127 
in disturbed sleep, 239 
in dysentery, 207 
in dyspepsia, atonic, 194 
intestinal, 204 
nervous, 200 
in dysphagia, 189 
in dyspnea, in heart diseases, 229 
in eczema, 270 
in empyema, 222 
in epilepsy, 240 



Diet in fever, 150 
in flatulence, 211 
in floating kidney, 234 
in gall-stone disease, 220 
in gastritis, acute, 189 

chronic, 191 
in genito-urinary diseases, 232 
alcohol in, 232 
surgical, 235 
water in, 233 
in gout, 262 
in heart diseases, 225. See also 

Heart diseases. 
in hemorrhage in ulcer of stomach, 
of stomach, 198 
in hemorrhoids, 212 
in hives, 271 
in infantile scurvy, 265 
in infectious diseases, 155 
in inflammation of kidney, 280 
acute, 233 
chronic, 234 
of mouth in infants, 126 
in insanity, 250 
in insomnia, 239 
in intestinal catarrh, acute, 205 
chronic, 206 

with constipation, 206 . 
with diarrhea, 206 
diseases, 202 
indigestion, chronic, in children, 

obstruction, 209 
in laryngitis, 222 
in leanness, 270 
in liver diseases, 218 
in lung diseases, chronic, 223 
in malignant growths of intestine, 

in measles, 166 
in movable kidney, 234 
in mumps, 167 
in nephritis, 233, 234, 280 

Diet in nervous conditions of intes- 
tine, 211 
in nervous diseases, 237 
gastric disorders, 200 
in neuralgia, 239 
in neurasthenia, intestinal, 211 
in obesity, 265 
Banting, 268 
Ebstein's, 269 
Oertel's, 269 
treatment by, 268 
in palpitation of heart, 229 
in paralysis after diphtheria, 119 
in peritonitis, 216, 217 
in pleurisy, 222 
in pneumonia, 223 
in postdiphtheric paralysis, 169 
in pus in pleural cavity, 222 
in rabies, 170 
in rachitis, 132 
in renal calculi, 234 
in respiratory diseases, 222 
in rest cure, 245, 247 

schedule, 248 
in rheumatism, 169 
in rickets, 132 
in scarlet fever, 165 
in scorbutus, 265 
in scurvy, 265 

in shock after operation, 280 
in skin diseases, 270 
in small-pox, 165 
in stomach diseases, 171 

carbohydrates in, 185 

eggs in, 184 

fats in, 185 

fish in. 185 

fruits in, 185 

gelatinous, 184 

leguminous, 185 

Leube's scale, 177 

liquid, 184 

meats in, 184 

Penzoldt's, 180 



Diet in stomach diseases, proteins in, 

rules for eating, 186 
special factors, 186 
in surgical cases, 274 
in tetanus, 169 
in tuberculosis, 170 
advanced cases, 175 
alcohol in, 173 
beverages in, 173, 174 
cereals in, 172 
eggs in, 171 
fats in, 173 
fish in, 172 
forced, 175 
fruit in, 173 

gastric irritability and, 175 
meat in, 171 
meat-juice in, 172 
milk in, 170 
vegetables in, 173 
wheat in, 173 
with fever, 175 
in typhoid fever, 155 
atypical, 165 
complicated, 165 
convalescence and, 162 
digestive disturbances and, 161 
hemorrhage and, 161 
perforation and, 162 
in typhus fever, 165 
in ulcer of intestine, 208 

of stomach, 196 
in uric-acid diathesis, 234 
in urticaria, 271 
in variola, 165 
in vomiting, nervous, 200 
in wasting diseases in children, 131 
in Weir Mitchell's rest cure, 245 
in whooping-cough, 167 
in yellow fever, 169 
laparotomy and, 278 
Hght, 283 
lists, food values of articles, 30 

\ Diet lists, Leube's, 177 

Penzoldts, 180 

solid food, 29 
meat, 283 
milk, 283 

scale, Leube's, 177 
special, 283 

urine and, relations of, 232 
variation in, 20 
ward, 283 
Digestibility of foods, coefficients of, 

Digestion, 15 
appetite and, influence on, 21 
buccal, 15 
chemistry of, ii 
diet and, influence of, 20 
emotion and, influence of, 22 
exercise after meals and, 21 

before meals and, 21 
gastric, 15 

influence of various factors on, 19 
intestinal, 16 

meals and, influence of frequency 
of, 19 

influence of order of, 19 
of infants, 17 
of milk, 34 
physiology of, 11 
rest after meals and, 21 

before meals and, 21 
salivary, 15 
temperature of food and, influence 

on, 21 
Digestive disturbances in typhoid 

fever, diet in, 161 
Dilation of blood-vessels, diet in, 230 
of heart, sudden, diet in, 229 
of stomach, diet in, 192 
Diphtheria, diet in, 167 

after intubation, 168 

in paralysis after, 169 
Diseases from errors in diet, 89 
from food poisons, 89 



Dog's milk, composition, 33 
Drink, imperial, 287 

in tuberculosis, 173, 174 

in typhoid fever, 156 

nutritive, for delicate women, 317 
Dry cure, 273 

diet, 222 

wines, strong, 77 
Drying food to preserve, 81 
Ducks, 47 
Dujardin-Beaumetz's nutrient enema, 

Dysentery, diet in, 207 

from amoeba coli, 91 
Dyspepsia, atonic, diet in, 194 

intestinal, diet in, 204 

nervous, diet in, 200 
Dyspeptics, jelly for, 318 
Dysphagia, diet in, 189 
Dyspnea- in heart diseases, diet in, 


Earthy mineral waters, 70 
ICbstein's diet for obesity, 269 
Kchinococcus disease, 91 
Eczema, diet in, 270 
Edema in heart disease, diet in, 228 
Effervescent peptonized milk, 298 
Effervescing lemonade, 287 
Egg-albumin, 44 
Egg-and-brandy mixture, 285 

for infants, 285 
Egg-and-milk enema, 141 
Egg-nog, 44, 286 
beef- tea, 318 

Eggs, 43. 304 
absorption of, 24 
and milk, 304 
broth, 286 
composition, 48 
cordial, 286 
gruel, 317 
hard-boiled, 44, 304 
in stomach diseases, 184 

Eggs in tuberculosis, 171 

in typhoid fever, 159 

junket with, 200 

poached, beef broth with, 317 

raw, 44 

soft-cooked, 304 
Electricity in rest cure, 247 
Emotion, digestion and, influence of. 

Empyema, diet in, 222 
Enemata, nutrient, 141. See also 

Nutrient enemata. 
England, meals in, 19 
Enzymes, 15 
Epilepsy, diet in, 240 
Ergotism, 91 

Esophageal operations, diet after, 277 
Estraus materna graduate, 105, 106 
Ethers in wine, 'J^ 
Europe, meals in, 19 
Ewald's enema, 142 
Ewe's milk, composition, 33 
Exercise after meals, digestion and, 

before meals, digestion and, 21 

food and, relation, 18 
Extractives in vegetables, 51 

in wine, 77 

Face, operations about, diet after, 

Farina gruel, 291 
Farinaceous diet, 283 

foods with starch not predigested, 

with starch predigested, 85 

Fat, 13, 64 

absorption of, 23 

fuel value of, 14 

ham, 336 

in human milk, loi 

in vegetables, 51 

in stomach diseases, 185 

in tuberculosis, 173 



Fat, proteins, and carbohydrates in 

combination, quantity required, 

quantity required, 26 
shoulder, 336 
uses of, 14 
Feeding. See also Diet. 
abnormal methods, 143 
artificial, of child, 100 
breast, 95 

contra-indications, 99 

frequency, 97 
bottle, beginning, 108 
by stomach-tube, infant, 125 
during second year, 109 
forced, 150 

in stomach diseases, 188 

in tuberculosis, 175 
maternal, 95 

contra-indications, 99 

frequency, 97 
mixed, 99 
nasal, 149 

in infants, 126 
of children, 95 
of infants, 95. See also Infant 

rectal, 138 

procedure, 138 
refractory patients, 149 
sick, general rules, 145 

infants, 124 
through gastric fistulas, 282 

intestinal fistulas, 282 
unconscious patients, 149 
Fever, diet in, 150 

in tuberculosis, diet in, 175 
Figs, 58 

Filaria in water, 92 
Fish, 47 
absorption of, 24 
composition, 49 
cooking, 88 
in stomach diseases, 185 

Fish in tuberculosis, 172 

Fish-poisoning, 90 

Fistulas, gastric, feeding through, 282 

intestinal, feeding through, 282 
Flank steak, 332 
Flatulence, dietetic treatment, 211 

in heart disease, diet in, 228 
Flaxseed tea, 288 
Floating kidney, diet in, 234 
Flour, 52 

ball, 291 

gruel, 291 

peanut, 328 
Flour-ball gruel, 291 
Food, absorption of, 16, 22. See 
also Absorption. 

adulteration of, 92. See also Adul' 

age and, relation, 18 

animal, 32 

table of compositions, 48 

artificial preparations, 83 

ascaris lumbricoides in, 92 

canning of, 82 

classes, 32 

climate and, relation, 18 

coefficiency of digestibility, 22, 23 

concentrated, 80 

cooking, 86 
rapid, 89 

digestion of, 15. See also Diges- 

exercise and, relation, 18 

farinaceous, with starch not predi- 
gested, 85 
with starch predigested, 85 

for aged, 134 

fuel value of classes, 14, 23 

heredity and, relation, 17 

idiosyncrasies, 91 

nutritive ingredients of, 13 

values, table for computing, 30 

oxyuris vermicularis in, 92 

parasites taken with, 91 



Food, pin-worms in, 92 
poisons, diseases from, 89 
prepared from cows* milk, 84 
preservation of, 81. Sec also Pre- 
servation of food. 
proprietary, artificial, 84, 85 
quantity required, 26 
race and, relation, 18 
relation of, to various conditions, 

rest and, relation, 18 

round-worms in, 92 

sex and, relation, 18 

size of person and, relation, 18 

taenia in, 91 

tape-worms in, 91 

temperature of, influence on diges- 
tion, 21 

trichina in, 92 

values, table for computing, 30 

vegetable, 51. See also Vegetiiiles. 

weight of person and, relation, 18 
Food-poisoning, acute, 90 
Foot-and-mouth disease, 91 
Forced feeding, 150 

in stomach diseases, 188 
in tuberculosis, 175 
Fortified wines, 'J^ 
Fowl, 47 

composition, 48 
France, meals in, 19 
Freeman's pasteurizer, 40, 41 
Fruits, 57 

absorption of, 25 

composition, 60 

digestibility of, 57 

in stomach diseases, 185 

in tuberculosis, 173 
Fruit-sugar, 63 
Frying meat, 88 

Fuel value of food-materials, 14, 23 
Full diet, 283 
Fungi, 59 
Fusel oil, 75 

Galactotoxismus, 90 

Gall-stone disease, diet in, 220 

Game, 47 

Gastric digestion, 15 

fistulas, feeding through, 282 
irritability in tuberculosis, diet in, 

juice, action of, 15 
Gastritis, acute, diet in, 189 

chronic, diet in, 191 
Gavage in infants, 125 

in stomach diseases, 188 
Geese, 47 

composition, 48 
Gelatin, dishes made with, 319 

meat jellies with, 320 

meat jellies without, 318 
Gelatinoids, 12 

Gelatinous diet in stomach diseases, 
in typhoid fever, 159 
Geni to-urinary diseases, alcohol in, 
diet in, 232 
surgical, diet in, 235 
water in, 233 
Gin. 75 
Ginger, 64 
Glucose, 63 

Gluten bread in diabetes mellitus, 256 
recipe for, 321 

biscuit, Jeffries', 322 

gruel, 292 

pancakes, recipe, 321 

pudding, recipe, 321 
Glycerin in wine, 77 
Glycogen, 17 

Glycogenic function of liver, 17 
Goat's milk, composition, 33 
Gooseberries, 58 
Gout, diet in, 262 
Grain, beef broth with, 317 
Grain-poisoning, 90 
Gram calories, 14 



Grape cure in stomach diseases, 188 

juice, 288 
Grapes, 57 
( J rape-sugar, 63 
Gran urn gruel, imperial, 291 
Green vegetables, 55 
Gruel, arrowroot, 290 

barley, 290 

with beef extract, 317 

cereal, 289 

cornmeal, 292 

cracker, 291 

egg, 317 
farina, 291 
flour, 291 
flour-ball, 291 
gluten, 292 
imperial granum, 291 
milk, peptonized, 300 
oatmeal, 291 

Ham, 47 
composition, 48 
fat, 336 
Hard water, 68 
Hard-cooked eggs, 14, 304 
Hardtack, 80 

Hare-lip operation, diet after, 277 
Head, operations about, diet after, 

Heart, dilatation of, sudden, diet, 229 
diseases, diet in, 225 

general directions, 225 
dyspnea in, diet in, 229 
edema in, diet in, 228 
fl itulence in. diet in, 228 
Oerlel treatment, 228 
ruptured compensation in, diet 

in. 229 
stomach disturbances in, diet in, 
palpitation of, diet in, 229 
leat consumption, Rubner's table, 

Hemorrhage in typhoid fever, diet in, 

of stomach, diet in, 196, 198 
Hemorrhoids, dietetic treatment. 212 
Hen's eggs, 43 

composition, 48 
Heredity, food and, relation, 17 
Hip sirloin, 332 
Hives, 91 

diet in, 271 
Holt's method of milk modiflcation. 

Honey, 63 

Hook-worms in water, 92 
Horseradish, 64 
Hospital diet, 283 

enema, 143 
Hot egg-nog, 286 

peptonized milk, 298 
House diet, 283 
Huckleberries, 58 
Human milk. See Milk, human. 
Humanized milk, 42 
Hydatid disease, 91 
Hydrocarbons, 13 

Iced meat extract, 312 

panopepton, 315 
Iceland moss, 59 
Ichthyotoxismus, 90 
Imperial drink, 287 
granum gruel, 291 
Indigestion, chronic intestinal, in 

children, diet in, 131 
Infantile scuivy, diet in, 265 
Infants, brandy-and-egg mixture for, 
diarrhea of, 127 
digestion of, 17 
feeding. 95 
artificial, 100 
bottle, beginning, io3 
breast, 95 

contra-indications, 99 



Infants, feeding, breast, frequency, 97 
by stomach-tube, 125 
during second year, 109 
during sickness, 124 
from eighteenth month to two 

and one-half years, 113 
from fifteenth to eighteenth 

months, 112 
from twelfth to fifteenth months, 

from two and one-half to six 

years, 114 
in asylums, 123 

in inflammations of mouth, 126 
in stomach diseases, 127 
maternal, 95 
contra-indications, 99 
frequency, 97 
mixed, 99 
nasal, 126 

theoretic basis of, 102 
wet-nursing, 99 
vomiting, 124 
Infectious diseases, diet in, 155 
Inflammations of mouth, infant feed- 
ing in, 126 
Infusions, saline, 143 
Injections, saline, 143 
Insane, diet for, 250 
Insomnia, diet in, 239 
Intestinal catarrh, acute, diet in, 205 
chronic, diet in, 206 

with constipation, diet in, 206 
with diarrhea, diet in, 206 
digestion, 16 
diseases, diet in, 202 
dyspepsia, diet in, 204 
fistulas, feeding through, 282 
indigestion, chronic, in children, 
diet in, 131 
Intestine, malignant growths of, diet 
in, 208 
nervous conditions of, dietetic 
treatment, 211 


Intestine, obstruction of, diet in, 209 
operations on, diet after, 281 
ulcer of, diet in, 208 

Intubation in diphtheria, diet after, 168 

Inulin biscuit, 327 

Irish moss, 59 
and milk, 303 
meat jellies with, 321 

Irish-moss blanc-mange, 320 

Iron, 66 
waters, 70 

Jaccoud's enema, 143 
Jeffries' gluten biscuit, 322 
Jelly, albuminized, 321 
barley, 292 
chicken, 318 
coffee, 320 
for dyspeptics, 318 
lemon, 320 
meat, 318 

with gelatin, 320 

with Irish moss, 321 

with tapioca, 320 

without gelatin, 318 
milk, 320 

peptonized, 299 
oatmeal, 292 
orange, 320 
panopepton, 315 

with orange, 316 
tapioca, 293 
veal-bone, 318 
wine, 319 
Junket, 300 

almond, bitter, 301 
cocoa, 300 
coffee, 301 
strawberry, 301 
vanilla, 301 
with eggs, 300 

Kefir, 36 

Kidney, calculi in, diet in, 234 



Kidney, floating, diet in, 234 
inflammation of, acute, diet in, 233 
chronic, diet in, 234 
diet in, 233, 234, 280 
movable, diet in, 234 
operations on, diet after, 280 

Kntripp cure, 273 

Knuckles, 333 

Kri'otoxismus, 90 

Kumiss, 36, 302 

LA( TEALS, 16 
Lactose, 63 
Lamb, 47 

composition, 48 

cuts of, 333 
Laparotomy, diet and, 278 
I^ird, leaf, 336 

Laryngeal operations, diet after, 277 
Laryngitis, diet in, 222 
I^thyrism, 91 
I^ad as adulterant, 94 
Leaf lard, 336 
leanness, diet in, 270 
Legumes, 53 

absorption of, 25 

in stomach diseases, 185 
Legumin, 84 
Lemon jelly, 320 

whey, 302 
Lemonade, 287 

albuminized, 287 

effervescing, 287 

milk, 301 

peptonized, 299 
Lemons, 57 
I-,entils, 54 
lettuce, 55 

stewed, 327 
Leube's diet lists, 177 
Levulose, 63 
Lichens, 59 
Light custard, 327 

diet, 283 

Lime water, 285 
Linseed tea, 288 
Liqueurs, 75 
Liquors, malt, 76 
action of, 79 
uses of, 79 
Liver diseases, diet in, 218 

glycogenic function of, 17 

in absorption, 17 
Llama's milk, composition, 33 
Lobster, 50 

composition, 49 
Loin, small end of, 332 
Lumpy-jaw, 91 

Lung diseases, chronic, diet in, 223 
Lupinosis, 91 

Maidismus, 91 

Maise, fermented, poisoning from, 91 
Malt extracts, 85 
liquors, 76 

action of, 79 

uses of, 79 
Mare's milk, composition, 33 
Massage in rest cure, 246 
Materna graduate, 105, 106 

method of milk modification, 

Maternal feeding, 95 

contra-indications, 99 
frequency, 97 
Matzoon, 36 

Meals, exercise after, digestion and, 
before, digestion and, 21 
frequency of, influence on diges- 
tion, 19 
in England, 19 
in Kurope, 19 
in France, 19 

in tuberculosis, number, 174 
order of, influence on digestion, 

rest after, digestion and, 21 



Meals, rest before, digestion and, 21 

sleep after, 21 
Measles, diet in, 166 
Measures, 337 
Meat. 44, 305 
absorption of, 24 
baking, 87 
boiling, 86 
braising, 87 
broiling, 88, 307 
broth, 309 
cooking, 86, 307 

effect of, 88 
cuts of, 330 
diet of, 283 

in tuberculosis, 171 
digestibility of, 45 
extract of, iced, 312 
frying, 88 

in stomach diseases, 184 
jelly, 318 

with gelatin, 320 

with Irish moss, 321 

with tapioca, 320 

without gelatin, 318 
juice, 312 

in tuberculosis, 172 

raw, 312 
mutton broth without, 31 
pan-broiling, 307 
powders, 46 
preparations, 44, 45 
preparing, 305 

raw, with milk and sugar, 315 
roasting, 87, 307 
soups without, 296 
stewing, 87 
Meat-poisoning, 90 
Melons, 58 
Metabolism, 14 
Metric and apothecaries' weights, 

relative values, 339 
and avoirdupois weights, relative 

values, 338 

Metric fluid and apothecaries' meas- 
ures, relative values, 337 
Milk, 32 
absorption of, 24 
adulteration of, 34 
albuminized, 303 
almond, 285 
and eggs, 304 

and sugar, raw meat with, 315 
butter-, 36 
composition, 32 

of various kinds, 33 
condensed, 43 
pontamination of, 37. 

precautions, 38 
cows', composition, 33, 34 

foods prepared from, 84 
cream of, 35 
curd, 36 
cure, 272 

in stomach diseases, 187 
diet, 283 

in tuberculosis, 170 
digestibility of, increasing, 42 
digestion of, 34 
from tuberculous cows, 37 
gruel, peptonized, 300 
human, fat in, loi 

salts in, loi 

milk-sugar in, 100 

modification of, 98 

proteins in, 100 

reaction, loi 

sugar in, 100 
humanized, 42 
infected, 92 
in typhoid fever, 157 

modified, 157 
Irish moss and, 303 
jelly, 320 

peptonized, 299 
lemonade, 301 

peptonized, 299 
mixture, 302 



Milk modification. 57. loi 
at home, technic. 108 
Haner's method, 107 
Holt's method, 102 
laboratory method, loi 
materna graduate method, 105 
top-milk method, 103 
modified, 38 

in typhoid fever, 157 
mother's. See Milk, human. 
Pasteurization of, 39 
peptonized, 298 
cold process. 298 
effervescent, 298 
hot. 298 
partially, 297 
specially, 298 
warm process, 298 
porridge. 301 
predigestion of, 42 
preparations, 297 
preservation of, 37 
products, 32 
punch, 301 

peptonized, 299 
skimmed, 35 
sterilization of, 39 

process. 40 
sugar-free for diabetics, 328 
variations in, 33 
with other diluents, 303 
with sparkling waters, 303 
woman's, composition, 33 
Milk-and-cereal waters. 303 
Milk-and-cinnamon drink, 303 
Milk-and-cgg enema, 141 
Milk-and-starch enema, 141 
Milk-and-sugar enema, 142 
Milk pepton enema, von I^ube's, 

Milk-poisoning, 90 
Milk-sugar, 63 

in human milk, 100 
Mineral waters, 68 

Mineral waters, alkaline, 69 

bitter, 70 

earthy, 70 

iron, 70 

sodium chlorid, 69 

sulphurous, 70 

uses of, in body, 14 
Modified milk, 38 

in typhoid fever, 157 
Molasses, 63 
Mollusks, 50 
composition, 49 

Morels, 59 

Mosquera beef meal, 46, 83 

Moss, Iceland, 59 

Irish, 59 
and milk, 303 
meat jellies with, 321 
Mother's milk. See Milk, human. 
Mouth in typhoid fever, care of, 160 

inflammations of, in&nt feeding in, 
Movable kidney, diet in, 234 
Mulberries. 58 
Mulled wine, 288 
Mumps, diet in, 167 
Mush, cereal, 289 
Mushroom-poisoning, 90 
Mushrooms, 59 
Mussel-poisoning, 90 
Mustard, 64 
Mutton, 46 

broth, 309 

with vegetables, 310 
without meat, 310 

composition, 48 

cuts of, 333 
Mytilotoxismus, 90 

Nasal feeding, 149 

in infants, 126 
Nausea after operations, 279 
Navel end of plate, 331 



Nephritis, diet in, 233, 234, 280 
Nervous diseases, diet in, 237 

rest cure in, 244 
dyspepsia, diet in, 200 
gastric disorders, diet in, 200 
vomiting, diet in, 211 
Neuralgia, diet in, 239 
Neurasthenia, intestinal, diet in, 211 
Nursing bottle, hygenic, 99 
child, 95. ^QQ dX's^ Infant feeding, 
wet, 99 
Nut-brown bread, 294 
Nutmeg, 64 
Nutrient enemata, 141 

army, 143 

Boas', 143 

Dujardin-Beaumetz's, 141 

egg-and-milk, 141 

Ewald's, 142 

hospital, 143 

Jaccoud's, 143 

milk-and-egg, 141 

milk-and-starch, 141 

milk-and-sugar, 142 

milk-pepton, von Leube's, 141 

pancreas, 142 

Riegel's, 142 

Singer's, 142 

starch-and-milk, 141 

sugar-and-milk, 142 

von Leube's milk-pepton, 141 
Nutrients, uses of, 14 
Nuts. 58 

Oatmeal, 53 
beef tea with, 311 
g:ruel, 291 
jelly, 292 
water, 288 
Obesity, diet in, 265 
Banting's, 268 
Ebstein's, 269 
Oertel's, 269 
treatment by, 268 

Obesity, prophylaxis in, 268 
Oertel's treatment of heart disease, 
of obesity, 269 
Oils, 64 

cod-liver, 65 
Oleomargarin, 65 
Olives, 58 
Operations about face, diet after, 277 

about head, diet after, 276 

bowels after, 279 

brain, diet after, 277 

cleft palate, diet after, 277 

diet after, 275 

dietetic management, 274 

esophageal, diet after, 277 

hare-lip, diet after, 277 

laparotomy, diet after, 278 

laryngeal, diet after, 277 

nausea after, 279 

on intestines, diet after, 281 

on kidney, diet after, 280 

on pancreas, diet after, 280 

on rectum, diet after, 281 

on stomach, diet after, 280 

on various organs, diet after, 280 

plastic, diet after, 277 

shock after, diet and, 280 

thirst after, 279 

vomiting after, 279 
Orange jelly, 320 

with panopepton jelly, 316 
Orangeade, 287 
Oranges, 57 
Orgeat, 288 

Oxyuris vcrmicularis in food, 91 
Oyster, 50 

composition, 49 

juice, 310 

peptonized, 33 

stew, 297 

Palate, cleft, operation for, diet 
after, 279 



Palpitation of heart, diet in, 229 
Pan-broiling meats, 307 
Pancakes, aleuronat, 324 

cocoanut, 325 

gluten, recipe, 321 
Pancreas enema, 142 

operations on, diet after, 280 
Pancreatic juice, 16 
Panopepton, 315 

bouillon, hot, 316 

cordial, 316 

hot, 316 

iced, 315 

jelly. 315 

with orange, 316 

with whey, 316 
Paralysis after diphtheria, diet in, 169 
Parasites taken with food, 91 
Parsnips, 55 

Pasteurization of milk, 39 
Pasteurizer, Freeman's, 40, 41 
Peaches, 57 
Peanut flour, 328 
Pears, 57 
Peas, S3, 54 

absorption of, 25 
Pellagra, 91 
Pemmican, 83 
Penzoldt's diet Hsts, 180 

table of food digestibility, 178 
Peppers, 64 
Pepsin, 15 

Pepton products, 83 
Peptonized beef, 314 

milk, 297. See also Milk, pep- 

oysters, 313 
Perfect wines, 78 
Perforation in typhoid fever, diet in, 

Peritonitis, diet in, 216, 217 
Phosphorus, 66 
Physiology of digestion, 11 
Pigeons, 47 

Pin-worms, 92 

Plastic operations, diet after, 277 

Pleural cavity, pus in, diet in, 222 

Pleurisy, diet in, 222 

Plums, 58 

Pneumonia, diet in, 223 

from spoiled meat, 90 
Poached ft^g, beef broth with, 317 
Poisoning, cheese-, 90 

fish, 90 

food, acute, 90 
diseases from, 89 

from chick-pea, 91 

from fermented maise, 91 

from spurred rye, 91 

grain, 90 

meat, 90 

milk, 90 

mushrooms, 90 

mussel, 90 

ptomain, 90 

sausage, 90 
Pork, 47 

composition, 48 

cuts of, 334 
Porridge, milk, 301 
Porter, 76 

Postdiphtheric paralysis, diet in, 169 
Potassium chlorid, 66 
Potato, 54 

soup, cream of, 297 

sweet, 54 
Poultry, 47 

composition, 48 
Predigestion of milk, 42 
Pregnancy, diet during, 136 

diseases of, diet in, 137 
Preservation of food, 81 

by antiseptic chemicals, 82 

by antiseptics, 82 

by canning, 82 

by cold, 82 

by drying, 81 

by excluding air, 81 



Preservation of food by other anti- 
septics, 82 
by salting, 82 
by sugar solution, 82 
by vinegar, 82 
Preservatives, 94 

Proprietary foods, artificial, 84, 85 
Proteids, 12 
Proteins, 12 

absorption of, 23 

carbohydrates, and fats in combina- 
tion, quantity required, 27 

concentrated, 80 

fuel value of, 14 

in human milk, 100 

in stomach diseases, 183 

in typhoid fever, 159 

in vegetables, 51 

quantity required, 26 

uses of, 14 
Prunes, 58 

Ptomain-poisoning, 90 
Ptomains, 90 
Pudding, almond, 323 

cocoanut, 326 

gluten, recipe for, 321 

suet, aleuronat and, 325 
Puerperium, diet during, 136 
Pulled bread, 294 
Punch, milk, 301 

peptonized, 299 
Puree, chestnut, 293 
I*us in pleural cavity, diet in, 222 

Rabbit, 47 
Rabies, diet in, 170 
Racahout des Arabes, 291 
Race, food and, relation, 18 
Rachitis, diet in, 132 
Raisins, 58 
Raspberries, 58 
Raw beef, preparing, 314 
soup, 315 
eggs- 44 

Raw meat with milk and sugar, 315 
Raw-meat juice, 312 
Recipes, 285 

for diabetics, 321 
Rectal feeding, 138 
procedure, 138 
Rectum, operations on, diet after, 281 
Renal calcuh, diet in, 234 
Rennin, 16 

Respiratory diseases, diet in, 222 
Rest after meals, digestion and, 21 

before meals, digestion and, 21 

cure, 244 

diet in, 245, 247 
schedule, 248 
electricity in, 247 
in stomach diseases, 187 
massage in, 246 
schedule for, 248 

food and, relation, 18 
Rheumatism, diet in, 169 
Rice, 53 

absorption of, 25 

water, 288 
Richard's ideal ration of solid food, 

Rickets, diet in, 132 
Riegel's enema, 142 
Roasting meat, 87, 307 
Roots, 54 

absorption of, 25 
Rough wines, 78 
Round, top, 332 
Round-worms in food, 92 
Rubner's tables of heat consumption, 

Rum, 75 
Rump steak, 332 

Ruptured compensation, diet in, 229 
Rye, spurred, poisoning from, 91 

Saccharin, 63 
Saline infusions. 143 
injections, 143 



Salivary digestion, 15 

Salting of food to preserve, 82 

Salts, 66 

in body, 12 

in human milk, loi 
Sauces, 64 

for vegetables, 296 
Sausage-poisoning, 90 
Scarlet fever, diet in, 165 
School children, diet for, 119 
Scorbutus, diet in, 265 
Scurvy, diet in, 265 
Second year, feeding during, 108 
Sex, food and, relation, 18 
Shell-fish, 50 

composition, 49 
Shock after operation, diet and, 280 
Short steak, 332 
Shoulder fat, 336 
Sick, feeding of, general rules, 145 

infants, feeding of, 124 
Singer's enema, 142 
Sirloin, 332 
Sitotoxismus, 91 

Size of person, food and, relation, 18 
Skimmed milk, 35 
Skin diseases, diet in, 270 
Sleep after meals, 21 

disturbed, diet in, 239 
Small-pox, diet in, 165 
Sodium chlorid, 66 

waters, 69 
Soft water, 68 
Soft-c(Joked eggs, 304 
Somatose, 46, 84 
Soups, beef, raw, 315 

celery, cream of, 297 

chestnut, 293 

composition, 48 

cream-of-celery, 297 

cream -of-potato, 297 

crcam-of-tomato, 296 

from stock, 308 

potato, cream of, 297 

Soups, preparing, 307 

raw beef, 315 

stock, 308 

from beef extract, 308 

sweetbread, 309 

tapioca, 293 

tomato, cream of, 296 

without meat, 296 
Soya biscuits in diabetes mellitus, 

Spare ribs, 335 

Sparkling waters, milk with, 303 

wines, 78 
Spices, 63 
Spinach, 55 
Spirits, 74 

Spurred rye, poisoning from, 91 
Stage of broken compensation, 225 

of compensation, 225 
Starch in vegetables, 51 
Starch-and-milk enema, 141 
Steak, flank, 332 
rump, 332 
short, 332 
Steapsin, 16 
Sterilization of milk, 39 

process, 40 
Sterilizer, Arnold, 39 
Stew, oyster, 290 
Stewed lettuce, 327 
Stewing meat, 87 
Stimulants, 66 

Stomach, carcinoma of, diet in, 199 
digestion, 15 
dilation of, diet in, 192 
diseases, diet in, 176 

carbohydrates in, 185 
eggs in. 184 
fats in, 185 
fish in, 185 
fruits in, 185 
gelatinous, 184 
leguminous, 185 
liquid, 184 



Stomach diseases, diet in, meats in, 
special factors, 186 
forced feeding in, 188 
gavage in, 188 
grape cure in, 188 
in infants, diet in, 183 
Leube's diet scale in, 177 
milk cure, 189 
Penzoldt's diet lists, 180 
rest cure, 187 
rules for eating in, 186 
treatment, special, 187 
Weir Mitchell cure, 187 
disturbances in heart disease, diet 

in, 229 
hemorrhage of, diet in, 198 

in ulcer of stomach, diet in, 196 
nervous disorders of, diet in, 200 
operations on, diet after, 280 
ulcer of, diet in, 196 
Stomach-tube in infant feeding, 125 
Stout, 76 
Strawberries, 58 
Strawberry junket, 301 
Strong^lus duodenale in water, 92 
Succus carnis, 312 
Suet pudding, aleuronat and, 325 
Sugar, 62 
and milk, raw meat with, 315 
cane-, 62 
fruit-, 63 
grape-, 63 
in human milk, 100 
in vegetables, 51 
in wine, 77 
milk-, 63 

solution in preserving food, 82 
Sugar-and-milk enema, 142 
Sugar-free milk for diabetics, 328 
Sulphur, 66 
Sulphurous waters, 70 
Suralimentation in tuberculosis, 175 
Surgical cases, diet in, 274 

Swallowing, difficult, diet in, 189 
Sweet potato, 54 

wines, strong, 78 
Sweetbread soup, 309 
Syrup, 63 

TyKNiA, 91 

echinococcus, disease from, 91 
Tamarind water, 287 
Tapeworms, 91 
Tapioca soup, 293 

jelly, 293 

meat jellies with, 320 
Tea, 70 

beef, 310 
egg-nog, 318 
flavored, 311 
with oatmeal, 311 

flaxseed, 288 

linseed, 288 
Terrapin, composition, 49 
Tetanus, diet in, 169 
Thermal waters, 69 
Thirst after operations, 279 
Thoracic duct, 16 
Tomato sauce, 64 

soup, cream of, 296 
Tomatoes, 56 

Top-milk method of milk modifica- 
tion, 102 
Top round, 332 
Torrified bread in diabetes mellitus, 

Toxins, 90 
Treacle, 63 
Trichina in food, 92 
Truffles, 59 
Trypsin, 16 
Tuberculosis, beverages in, 174 

bovine, milk contamination in, 37 

diet in, 170 
advanced cases, 175 
alcohol in, 173 
cereals in, 172 



Tuberculosis, diet in, eggs in, 171 

fats in, 173 ; fruit in, 173 

fever and, 175 

fish in, 172 

forced, 175 

in gastric irritability, 175 

meat in, 171 
juice in, 172 

milk in, 170 

number of meals, 174 

vegetables in, 173 

wheat in, 173 
sural! mentation in, 175 
Tubers, 54 

absorption of, 25 
Turkey, composition, 48 
Turtle, composition, 49 
Typhoid fever, alcohol in, 160 

atypical, diet in, 165 

carbohydrates in, 158 

complicated, diet in, 165 

convalescence, diet in, 162 

diet in, 155 
in digestive disturbances, 161 

drink in, 156 

eggs in, 159 

gelatinous substances in. 159 

hemorrhage in, diet m, 161 

milk in, 157 
modified, 157 

mouth in, care of, 160 

perforation in, diet in, 162 

proteins in, 159 
Typhus fever, diet in, 165 
Tyrotoxismus, 90 

Ulcer of intestine, diet in, 208 

of stomach, diet in, 196 
Unconscious patients, feeding, 149 
Urea, 17 

Uric-acid diathesis, diet in, 234 
Urine and food, relations of, 232 
Urticaria, 91 

diet in, 271 

Vanilla junket, 301 
Variola, diet in, 165 
Veal, 46 

broth, 309, 310 

composition, 48 

cuts of, 332 
Veal-bone jelly, 318 
Vegetables, 51, 295 

absorption of. 24 

carbohydrates of, 51 

composition, 61 

concentrated, 80 . 

cooking, 295 
effect of, 88 
time for, 295 

digestibility of, 51 

extractives in, 51 

fats in, 51 

green, 55 

absorption of, 25 

in tuberculosis, 173 

mutton broth with, 310 

protein in, 51 

sauce 296 

starch in, 51 

sugar in, 51 
Vegetarianism, 56 
Venison, 47 
Vinegar, 64 

in preserving food, 82 
Vomiting after operations, 279 

infant, 124 

nervous, diet in, 200 
von Leube's milk-pepton enema, 141 

von Noorden's carbohydrate-free 
diet in diabetes mellitus, 254 

Walnuts, 59 

Ward diet, 283 

Wasting diseases in children, diet in, 

Water, 66 

acratothermal, 70 
alkaline, 69 



Water, amoeba coli in, 91 
amount consumed, 67 
bitter, 70 
earthy, 70 
elimination of, 67 
filaria in, 92 
hard, 68 

hook-worms in, 92 
impurities in, 68 
in body tissues, 12 
in genito-urinary diseases, 233 
iron, 70 
mineral, 68 
purification of, 68 
sodium chlorid, 69 
soft, 68 

strongylus duodenale in, 92 
sulphurous, 70 
thermal, 69 
Weight of infant, 124 

of person, food and, relation, 18 
Weights, 337 

Weir Mitchell cure for stomach dis- 
eases, 187 
rest cure, 245. See also Rest 
Wet-nursing, 99 
Wheat, 52 ' 
bread, whole, 294 
in tuberculosis, 173 
Whey. 36, 300, 301 
cream-of-tartar, 302 
lemon, 302 

Whey, wine, 302 

with pano|5epton, 316 
Whisky, 75 

Whole-wheat bread, 294 
Whooping-cough, diet in, 167 
Wine, 76 
acid, 78 
acids in, 76 
action of, 79 
alcohol in, 76 
aromatic, 78 
dry, strong. 77 
ethers in, 77 
extractives in, 77 
fortified, 77 
glycerin in, 77 
jelly, 319 
mulled, 288 
perfect, 78 
rough, 78 
sparkling, 78 
sugar in, 77 
sweet, strong, 78 
uses of, 79 
varieties, 77 
whey, 302 
Woman's milk, composition, 33 
Women, delicate, nutritive drink for, 

Wood alcohol as adulterant, 94 
Worcestershire sauce, 64 

Yellow fever, diet in, 169 




.1 ! 


Books qn nursing 


Book* tent to any part of the world on receipt of price 

Abbolt's Hygiene of TransmLsjible DUesia 10 

Amoican Illustrated Medical Dictionary 9 

American Pocket Medical Dictionary 2 

Barton and WelU' Medical Thesfluruj 5 

Beck'i Reference Handbook for Nurta 4 

Bergey's Principlei of Hygieoe 8 

Davis' Obstetrical Nursing 3 

De Lee's Obstetrics ior NurBei II 

Friedcaiwald and Ruhrah') Diet 8 

Friedenwald and Rubiah's Dietetics for Nurses II 

Galbiailh'i Four Epoch" ol Woman's Life .... 6 

Glalstrom's Mechano-Therapy 6 

Griffith's Care oi the Baby 5 

Lewis' Anatomy and Physiology for Nurses 4 

Martin's Essentials ol Minor Surgery and Bandaging 6 

Morris' Materia Medica. Tlierapeutics, PrescrHHion-Wrilina .... 7 

Nancrede's Essenliab of Anatomy 8 

Paul's Nursing in Acute Infectious Fevers 9 

Pyle's Persona! Hygiene 5 

Stevens' Manual of Practice of Medicine 7 

Stevens' Modem Materia Medica and Therapeutics 7 

Stoney's Materia Medica lor Nurses 4 

Sloney'i Practical PoinB in Nursing . 2 

Stoney's Surgical Technic for Nurses 3 

Warwick and Tunstall's Rrst Aid to the Injured and Sick 10 

Williams' Practice of Medicine 6 



9, HenrietU Street, Covent Garden, London 


Practical Points in INjursin g, recently issueo 

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\,KT-^\:\ea\r— American Journal of Obslelrici and Dheasli of WomtH and CkUdren. 

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By Edward P. Davis, A.M., M.D., Professor of Obstetrics in 
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Anatomy and Physiology for Nurses issued 

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A Thes auru s of Medical 

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"The BHlhorhas faithfully presented mndera IhErapeutks in a comprehensivE 
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Essentials of Materia Medica, Tliera- seventh 

^— ^^^^^^^^^^^^^^^^^^^^^— ^^^^-^^^ edition 

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Bergey's Principles of Hygiene. "I^^^J 

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. sugpealions that canni 
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Diet in Health and Disease. 

By Julius Friedenwald, M.D., Clinical Professor of Diseases 
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Children, College of Physicians and Surgeons, Baltimore, Oc- 
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The American Illustrated ^et the Best 

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Muscles, Nerves, Veins, etc. ; of Bacilli, Bacteria, Micrococci, 
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Borland, M. D. large octavo, nearly Soo pages, bound in full 
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It furnishes a maximum amount of matter in a mlalmum 
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mnd Clinical Surgery. Univtrsily of Buffalo. 

Nursing in the Acute Infectious Fevers, issleo 

By George P. Paul, M.D., Assistant Visiting Physician and 
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Dr. Paul has written this little work especially for the trained 
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The Hygiene of Transmissible Diseases. 

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aclilloner wishing to obtain a cl 

en long felt by 
irly written and 

knowledge of hygiene and 
of the profession, which ai 
— Thi Medical News. 

in harmony with the efforH 
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First Aid to the Injured and Sick. ^| 

First Aid to the Injured and Sick. By F. J. Warwick, B. A., 
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It only lo nurses, railway em{ilo)ree5, elc, but also to the laity 


Obstetrics for Nurses. 


Obstetrics for Nurses. By Joseph B. DeLee, M.D., Professor 
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The photographs were taken from actual scenes, and the text is the 
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" iu eonlenls are very pracdcal and In accord wilh ihe present slanrt of sci- 

schools with which I am connected."— C. S. BACON. M. D., Pro/njnr of Ohlelria 
10 Ihi CoUtge of PkyHciam and Surgtoni, Chicago. 

Dietetics for Nurses. issu^ei* 

By Julius Friedenwald, M.D., Clinical Professor of Diseases 
of the Stomach, College of Physicians and Surgeons, Baltimore ; 
and John Ruhr.\h, M.D., Clinical Professor of Diseases of 
Children, College of Physicians and Surgeons, Baltimore. 
i2mo of 363 jiages. Cloth, $i.^o net. 

This work has been prepared to meet the needs of the nurse, 
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in nutrition. The subjects of infant feeding and the feeding o'f 
the sick are fully discussed, and a brief outline is given of the 
principles involved in the nourishment of patients suffering with ' 
the various diseases in which diet plays an important part in treat- 
ment. Rectal alimentation and the feeding of operative cases are 
fully described. 


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